This is written just after Senate Majority Leader Mitch McConnell (R-Kentucky) finally took the covers off the sleek new vehicle to repeal and replace Obamacare. Ordinary people are finally allowed to kick the tires. While the Senate was working on it, only a few Republican senators and no Democrats were allowed to peek.
Like the vehicle passed by the House, it does not repeal—let alone replace—Obamacare. Both bills simply repeal the taxes that funded Obamacare, most of which fell on well-to-do Americans. The only taxes that could have hit working class people depended on the unlikely circumstances of having a union contract so rich that the healthcare provision is subject to the “Cadillac tax” or being a habitué of tanning salons.
Having destroyed the funding base for Obamacare, both the House and Senate GOP bills “pay for” cutting taxes on the wealthy by kicking working class people off health insurance premium subsidies and kicking the poor off Medicaid.
Should one of these bills pass and be followed up by the Trump budget cuts in Medicaid, federal Medicaid dollars would be cut in half within 10 years. While Medicaid is a program aimed at the poor, the fact is that about half of all childbirths and two thirds of nursing home care in the country are paid by Medicaid. In rural America—where lots of Indians live—many hospitals, hospices, and nursing homes will not be able to keep their doors open without Medicaid reimbursements.
Having short memories, the Republicans have also made hash of a bargain with the medical service providers that got their assent to Obamacare. Providers agreed to accept less reimbursement under Medicaid based on the much greater numbers of poor people who would become covered by the Medicaid expansion in Obamacare.
The first blow to that bargain was the confederacy of dunces who refused to expand Medicaid after the SCOTUS held they could not be forced to expand Medicaid by withholding other federal funds. Most of those dunces were in the former Confederate States of America, which are different from the rest of the United States in so many ways—lower wages, less healthcare, less education but more guns and more Jesus.
The final blow to the bargain with care providers is the de-funding (not repeal) of Obamacare, leaving the doctors and hospitals stuck with the lower reimbursements they agreed to accept but without the great number of persons covered by health insurance Obamacare provided. The Republican bills also de-fund Planned Parenthood, because everybody knows that the way to stop a woman from getting an abortion is to take away her birth control pills.
While both the House and Senate versions take health insurance away from millions of people, they differ in the timing. It’s a big issue whether to stall the worst effects just past the mid-term elections or try to get a second term for Mr. Trump before the political chickens come home to roost.
Both versions finesse the insanely popular Obamacare rule that nobody can be denied health insurance because of a preexisting condition. That rule comes joined at the hip with the mandate that everyone must buy health insurance. Without the mandate, people could go naked until they got sick and then buy insurance.
The Republicans have taken the position that the ability to go naked until you get sick and then take a free ride on premiums paid by others during the time you were naked is a fundamental human freedom. This is where the insanity kicks in.
The dreaded freedom-killing mandate remains in the law but the penalties for violating it are repealed. In fairness to the Republicans, they would no doubt repeal the mandate if they could, but then the bill could not be approved by reconciliation and the Democrats could kill it with a filibuster.
Without the horrid, totalitarian mandate that American citizens are not free to go without health insurance, how can they protect the pocketbooks of the insurance companies? No problem. While the government no longer can punish you for going naked, the insurance companies can tack a 30 percent surcharge on your premium if your coverage has lapsed for as many as 63 days in the year before you are seeking coverage. They can do the same if you age out of your parents’ health insurance and you fail to buy your own in the next open enrollment period.
See the difference? If the government whacks you, then you are laboring under the bootheel of a totalitarian system with no respect for freedom. If a corporation whacks you for the same conduct, the freedom of corporate persons to whack human persons outweighs any interest a human person might have in not being whacked at all.
There is now Congressional Budget Office scoring on the Senate version, so we know 22 million people will lose health insurance. Obamacare brought the uninsured population down from over 18 percent to under 10 percent. Pulling the funding plug on Obamacare sends the uninsured population back up to almost 18 percent, for which the Senate produces a $760 billion tax cut for the wealthy. The House version takes insurance away from a few more people but the tax cut is $763 billion.
Like the House plan, the Senate will allow elders to be charged more for being old. The algebra to determine how much more is complicated, but the general philosophical principle being acted out is that if your health care costs more because you are old or female or you have a preexisting condition then you should pay higher premiums.
The Democrats, as a general principle, believe that the young and healthy should subsidize the old and infirm and men should subsidize women and we should all subsidize cancer victims because we are all in this together and nobody gets out alive, anyway.
This philosophical difference keeps coming up in the debate, often enough that a Republican male will stand up and object that he is paying for insurance that covers the expenses of childbirth when he never intends to be pregnant.
The difference was front and center when Jimmy Kimmel told the emotional story of his son’s heart condition at birth, and it motivated former Congressman Joe Walsh to focus like a laser on the “real” issue:
Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.
Maybe not, Mr. Walsh, but what about the fact that all of us will be helpless at least twice in our lives: at birth and for some time afterwards and as we near our death.
My recent battle with cancer reminded me of my age and how temporary my victory is. I came away with a reawakened awareness that I am blessed with family and friends and employers and a team of medical professionals who pick me up and carry me when I can’t carry myself, just as people did when I was a newborn and just as I did for my kids and for my mother.
If this natural cycle means anything it should teach the Joe Walshes of the world that, to repeat myself, we are all in this together and nobody gets out alive, anyway. That is the source of your obligation. If that’s a burden then the human life cycle is a burden.
The circular nature of these obligations brings me to the Indian Health Service, which is situated downstream from Medicaid and receives money as a consequence, money that goes toward the federal medical program with the lowest per patient expenditures.
Some readers of these words get their primary medical care from IHS, and those people have a dog in this fight the size of a great dane. My primary insurance is Medicare, and I have secondary health insurance attached to the retirement I draw from my first career. I’m eligible for IHS but I don’t use it. I have relatives who do. Indians all have at least a poodle in this fight, and a dog is a dog.
The House and Senate versions of health care “reform” do not repeal Obamacare. They simply move money from healthcare to a tax cut for the wealthy. They redistribute wealth from the have-nots to the haves, a redistribution that started with the Reagan Revolution and continues apace with a billionaire in the White House who has picked a billionaire cabinet.
Have I just engaged in “class warfare?” I suppose I have, to those who believe that the New Deal was governmental redistribution but the Reagan Revolution was dictated by the market. That is, the job creating smart people, since Reagan, don’t have to subsidize laziness and stupidity. Everyone knows the only obstacles to being a billionaire are laziness and stupidity. Have you noticed that it’s only class warfare when the working class fires back?
A large tax cut in the Senate version is what some call “an incentive for time-traveling job creators.” A 3.8 percent tax is repealed that applies only to investment income (capital gains and dividends) of individuals with an income of more than $200,000 a year or married couples who bring in $250,000 a year.
This Obamacare tax would not just be repealed, but repealed retroactively. This gives the people who are wealthy because they are smart the incentive to time-travel back to when they paid these taxes and create some jobs instead of paying for somebody else’s health care.
If I may pause for a tiny reality check, I just did two hospital stays in my fight with cancer. Both times, I thought there were lots and lots of jobs short of medical doctor involved in my care. Maybe I was mistaken because of heavy medication.
Because neither of the Republican bills repeals Obamacare, the bureaucracy remains in place and can easily be reactivated when enough people have died or been bankrupted to change the politics that has handed both houses of Congress and the White House to the job-creating, smart billionaires.
Those who think this vehicle to cut taxes for the wealthy can’t pass should understand Mitch McConnell to be an experienced salesman of legislative used cars and remember the health care laws going all the way back to Obamacare have been packed with accessories to win particular votes.
There was the Cornhusker Kickback then and the Buffalo Buyout now. There was the Louisiana Purchase of Sen. Mary Landrieu’s vote that suffered a drafting error ramping millions up to billions and changing the shorthand to Louisiana Lagniappe.
No amount of tacked on chrome can make the healthcare machine run. It requires fuel, and the Obamacare taxes that make it go were aimed at the wealthy because those were the only taxes that would pass.
I confess that I’m not wealthy enough to be paying Obamacare taxes, and my opinion may be colored by living among non-billionaires, but after finally being allowed to kick the tires on this vehicle, I don’t even want a test drive.
Steve Russell, Cherokee Nation of Oklahoma, is a retired Texas trial court judge and associate professor emeritus of criminal justice at Indiana University-Bloomington. He lives in Georgetown, Texas.