The Takeaway: Masters of Misdirection
If there is any takeaway from the double threat the AHCA, as reassessed by the CBO last week, and the Trump budget, which was also released last week, pose to our health and economic security, it is that it is vitally important to keep our eyes on what the people running the government in Washington actually do while regarding their words with extreme skepticism.
In the wake of both developments last week, we were treated to so many breathtaking whoppers that it is hard to know where to begin. If there were an award for double-speak, there would be a rich candidate pool from which to draw. Below are a few potential award winners.
Consider the double dishonesty of Paul Ryan, who continues to characterize his efforts to save the Affordable Care Act (ACA) insurance markets by destroying them as an act of compassion. Ryan continues to tout CBO’s finding that in the long run, premiums would go down under the AHCA. But he ignore the fact that the decrease in average premiums stems from a combination of increased out-of-pocket costs and excluding older and sicker people from coverage entirely. Furthermore, as the CBO analysis illustrates, not only would the AHCA undermine consumer protections and slash tax credits that make coverage affordable, but under the false flag of saving us from the ACA, it would fulfill Speaker Ryan’s lifelong dream of taking healthcare away from seniors, people with disabilities and low income children and families. The AHCA makes steep cuts both to the part of Medicaid the ACA expanded and the core program that has protected vulnerable populations for the last 50 years.
Or consider three health care promises of Donald Trump: not to cut Medicaid, to protect people with preexisting conditions and to make affordable coverage available to everyone, The CBO analysis and Trump’s own budget exposed these promises as lies last week (some, not for the first time). (He also promised not to cut Medicare or Social Security and has proposed or supported cuts in both of those programs.) To understand the dystopian future of health care the Trump administration envisions, you really have to read the budget proposal and AHCA together. AHCA has not even moved from the House to the Senate, and the administration is already doubling down on the cuts to Medicaid. While it is difficult to tease out exactly what the budget proposes, the reduction in federal funds to Medicaid could climb to as much as 45 percent within 10 years.
While we’re discussing the Trump budget, consider the sophistry of OMB Director Mick Mulvaney — having a Mitt Romney moment — who advanced the bogus distinction between taxpayers and recipients of health care benefits. Mulvaney conveniently ignored the fact that the people who receive coverage via the ACA, Medicaid and Medicare all pay taxes and the millions of people with employer-sponsored insurance enjoy a large tax subsidy.
And how are we to understand the words of Freedom Caucus co-chair Mark Meadows — who got choked up as recalled his family’s struggles with illness and claimed that those experiences had sensitized him to the problems of people with people with pre-existing conditions? Are we to believe that he really didn’t know how the bill he helped shape and push through the House would affect people with pre-existing conditions? Perhaps he should be taken literally, after all, he said he was not going to make a political decision on May 24th to take health care away from sick people. Technically that was a true statement, since he had made that decision weeks earlier when he voted to pass AHCA.
Finally, consider the words of Senate Majority leader Mitch McConnell who last week said, “I don’t know how we are going to get to 50 in the Senate.” A true statement, and different in nature than the others, but still easily misinterpreted. It would be as dangerous to read too much into McConnell’s seemingly innocuous statement as it would be to take the others’ statements at face value. Doing so could lull people into a false sense of security. Just because at this moment McConnell does not know the path to 50 votes or the content of a Senate bill should not be interpreted to mean that the Senate will not do a bill or that they will do a bill that departs drastically from the House proposal.
Although many Senators have voiced concerns about the House bill, we can no more rely on the “reasonableness” of the Senate than on the false words of Trump, Ryan and company. Remember, any lurch toward reason in the Senate runs smack into the prime directive of the modern GOP: that the solution to any problem is always a tax cut for the rich. Further, a bill in the Senate must reduce the deficit by the same amount as the House bill (now pegged at $119 billion by CBO). The combination of the deficit reduction target and the Republican Party’s commitment to big tax cuts for the rich spells big trouble for people with disabilities and preexisting conditions and for people of modest income who lack employer-sponsored insurance.
The only hope to avoid turning back the clock not only on the ACA, but also on Medicaid, is a massive show of resistance. This needs to start this week when Senators are home for recess and continue until they abandon their mad project of undermining the health and economic security of millions of people.
With thanks to Quynh Chi Nguyen, policy analyst, for her assistance.