Republican healthcare voters must be held accountable
At the Plum Line, we write a lot about the mechanics of politics — the processes of governing, the interplay of political forces, the back-and-forth between citizens and lawmakers, and so on. We do that because it is interesting and because it winds up affecting all our lives. But there are moments when you have to set aside the mechanics and focus intently on the substance of what government does — or, in this case, what government is trying to do.
I won't mince words. The healthcare Bill that the House of Representatives passed yesterday afternoon, in an incredibly narrow 217-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I cannot recall what it might have been. And every member of the House who voted for it must be held accountable. here is certainly a process critique one can make about this Bill. We may focus on the Republicans rushing to pass it without having held a single hearing on it, without a score from the Congressional Budget Office that would tell us exactly what the effects would be, and before nearly anyone has had a chance to even look at the Bill's actual text. All this despite them remaking one sixth of the American economy and affecting all of our lives — and despite their long and ridiculous claims that the Affordable Care Act was “rammed through” Congress, when in fact it was debated for an entire year and was the subject of dozens of hearings and endless public discussion). We may talk about how every leading stakeholder group — the American Medical Association, the American Hospital Association, the American Association of Retired Persons, the American Cancer Society Cancer Action Network, the American Heart Association, and on and on — all oppose the Bill. All that matters. But the real problem is what's in the Bill itself. Here are some of the things it does:
• Takes health insurance away from at least 24 million Americans; that was the number the CBO estimated for a previous version of the Bill, and the number for this one is probably higher
• Revokes the Affordable Care Act's expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans
• Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose
• Slashes Medicaid overall by $880 billion over ten years
• Removes the subsidies that the Affordable Care Act provided to help middle-income people afford health insurance, replacing them with far more meagre tax credits pegged not to people's income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit
• Allows insurers to charge dramatically higher premiums to older patients
• Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the Affordable Care Act. This also, it was revealed yesterday, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers
• Allows states to seek waivers from the Affordable Care Act's requirement that insurance plans include essential benefits for things such as emergency services, hospitalisation, mental health care, preventive care, maternity care and substance abuse treatment.
• Provides hundreds of billions of dollars in tax cuts for families making more than $250,000 a year
• Produces higher deductibles for patients
• Allows states to try to waive the Affordable Care Act's requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for pre-existing conditions, since insurers could charge you exorbitant premiums if you have a pre-existing condition, effectively denying you coverage
• Shunts those with pre-existing conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and cannot cover the population they are meant for. Multiple analyses have shown that the money the Bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance
• Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you will have to document every condition or ailment that you have ever had
It is no exaggeration to say that if it were to become law, this Bill would kill significant numbers of Americans. People who lose their Medicaid, do not go to the doctor, and wind up finding out too late that they are sick. People whose serious conditions put them up against lifetime limits, or render them unable to afford what is on offer in the high-risk pools, are suddenly unable to get treatment.
Those deaths are not abstractions, and those who vote to bring them about must be held to account. This can and should be a career-defining vote for every member of the House. No one who votes for something this vicious should be allowed to forget it — ever. They should be challenged about it at every town hall meeting, at every campaign debate, in every election and every day as the letters and phone calls from angry and betrayed constituents make clear the intensity of their revulsion at what their representatives have done.
Perhaps this Bill will never become law, and its harm may be averted. But that would not mitigate the moral responsibility of those who supported it. Members of Congress vote on a lot of inconsequential Bills and Bills that have a small impact on limited areas of American life. But this is one of the most critical moments in recent American political history. The Republican healthcare Bill is an act of monstrous cruelty. It should stain those who supported it to the end of their days.
• Paul Waldman is a contributor to The Plum Line blog, and a senior writer at The American Prospect magazine