Here’s what we know right now about the health-care plan Senate Republicans are working on: They want to pass it next week.
That’s just about it, and all we can say for sure. While there have been some leaks and rumors about what might be in it, that’s all they are. There haven’t been any hearings or legislative text for anyone to analyze. It’s been a backroom process that, whether there’s any cigar smoke or not, has been more secretive, according to the Senate’s historian emeritus, than any other in the past 100 years.
If you think this is a good way to restructure 18 percent of the American economy, well, then you must be Senate Majority Leader Mitch McConnell and the exclusive group of Republicans he’s letting in on the project — because it’s hard to see how anyone else could. There’s been no input from anyone who has anything to do with any part of the health-care system. Why, it’s almost as if Republicans weren’t acting in good faith when they complained that Obamacare, which actually did go through months of hearings and amendments, had, as the Senate’s now-No. 2 Republican John Cornyn put it at the time, happened “behind closed doors with secret [health-care] negotiations.”
Despite this lack of transparency, there are still a few things we can guess about. Whatever else it does, it seems like a good bet that the Senate GOP’s bill will have the same basic structure as the House GOP’s: a trillion-dollar tax cut for wealthy investors that’s paid for by slashing Medicaid for the poor and Obamacare subsidies for the middle class. Indeed, Cornyn has gone so far as to say that the two could be as much as 70 to 80 percent the same. And that, as Mother Jones’s Kevin Drum points out, is all we really need to know.
Now, that’s not to say that any differences between the two wouldn’t matter. They might. One that would is if the Senate bill really does cut Medicaid the way it’s been reported. Like the House bill, you see, it would reportedly turn Medicaid from an open-ended program that grows as needed to one that’s capped on a per capita basis and only grows according to inflation. Unlike the House bill, though, it would, starting in 2025, pick a much, much lower rate of inflation for Medicaid to grow by, eventually cutting the program by far more than even the 25 percent the House would.
The question, then, is how much money Republicans want to put in — or, more to the point, take out — of the health-care system? And the answer is it depends on how big a tax cut they want. That’s because they are required by rule to cut more in spending than they cut in taxes as a result of the way they’re trying to pass their plan with just 51 votes in the Senate. So as long as the GOP’s top priority is getting rid of the taxes on the rich that paid for Obamacare — and it is — then they’re going to end up having to get rid of an equal amount of health-care spending for everybody else. They can claim that cutting $1 trillion isn’t really cutting anything, since, as Health and Human Services Secretary Tom Price put it, states would have “greater flexibility” to find efficiencies; they can attack the nonpartisan Congressional Budget Office for saying that spending $1 trillion less on health insurance means a lot fewer people will have health insurance; they can even say it isn’t a big deal if these $1 trillion of cuts mean fewer people are covered because they’re just exercising their new freedom to go uninsured.
But they know that these aren’t convincing arguments. You can tell by the fact that they’re trying to avoid having to make them by keeping their bill hidden from view until the last possible moment.
After all, you don’t have to know a lot about policy to know that cutting health care by $1 trillion means a lot more people won’t have it. Even President Trump seems to have noticed that. He went from defending the plan with some of his trademark stream-of-consciousness braggadocio — it’s “getting better and better and better, and it’s gotten really good, and a lot of people are liking it a lot,” he told reporters in April — to now deciding that it was actually “mean” all along.
You just can’t cut taxes the way Republicans want and have “insurance for everybody” like Trump promised. Heck, you can’t even have cheaper insurance. On an apples-to-apples basis, the House Republican plan, at least, would probably increase premiums and deductibles, according to the center-left Brookings Institution and the nonpartisan Kaiser Family Foundation. To the extent that people would pay less, it would only be because they were getting less and people who needed more had been priced out of the market. None of this is going to change in the Senate version unless the GOP changes its commitment to cutting taxes for the rich.
So I guess that makes it two things we know about the Senate GOP’s health care plan: they want to pass it next week, and it will be something Trump thinks is mean.