Robinson: Senate ACA replacement guts Medicaid to cut taxes

By Eugene Robinson

The “health care bill” that Republicans are trying to pass in the Senate, like the one approved by the GOP majority in the House, isn’t really about health care at all. It’s the first step in a massive redistribution of wealth from struggling wage-earners to the rich — a theft of historic proportions.

Is the Senate version less “mean” than the House bill, to use President Trump’s description of that earlier effort? Not really. Does the new bill have the “heart” that Trump demanded? No, it doesn’t. The devil is not in the details, it’s in the big picture.

Fundamentally, what Republicans in both chambers want to do is cut nearly $1 trillion over the next decade from the Medicaid program, which presently serves almost 70 million people. Medicaid provides health care not just for the indigent and disabled but also for the working poor — low-wage employees who cannot afford health insurance, even the plans offered through their jobs.

Additionally, about 20 percent of Medicaid spending goes to provide nursing home care, including for middle-class seniors whose savings have been exhausted — a situation almost any of us might confront. Roughly two-thirds of those in nursing homes have their care paid by Medicaid.

Why would Republicans want to slash this vital program so severely? You will hear a lot of self-righteous huffing and puffing about the need for entitlement reform, but the GOP’s intention is not to use the savings to pay down the national debt. Instead, slashing Medicaid spending creates fiscal headroom for what is euphemistically being called “tax reform” — a soon-to-come package of huge tax cuts favoring the wealthy.

That’s the basic equation in both the House and Senate bills: Medicaid for tax cuts. Both bills start with various of the taxes imposed by the Affordable Care Act, but those are mere appetizers. The main course is intended to be big cuts in individual and corporate tax rates that would benefit the rich.

There is no other point to this whole exercise. All the “Obamacare is in a death spiral” talk is Republican wishful thinking, aided and abetted by active sabotage.

The ACA is far from perfect, but recall that it was designed with input from the insurance industry. The main reason so many insurers are pulling out of the program is that Congress and GOP-dominated state governments refuse to live up to their end of the bargain. Congress will not commit to funding promised subsidies to cover treatment for the poor and those with expensive ailments, or to keeping in place the mandate forcing individuals to buy insurance or pay a penalty. Republican governors and state legislatures refused to set up exchanges that would make insurance more affordable and declined the opportunity to expand Medicaid coverage.

It’s actually a wonder that the ACA works as well as it does, given the GOP’s determination to make it fail.

Neither the House nor the Senate bill fully dismantles the scaffolding of Obamacare; rather, they allow the states to do most of the dirty work. Philosophically, Republican majorities in both chambers want to erase the central concept that the ACA established: that health care is a fundamental right, not a privilege depending on one’s income.

Like the House, the Senate wants to offer tax credits rather than subsidies to help the needy afford insurance. Like the House, the Senate wants to leave up to the states whether policies must cover such services as emergency, maternity and mental health care. Like the House, the Senate wants to eliminate the requirement that large employers offer insurance plans to their workers.

There are a few distinctions, though I wouldn’t call them real differences. The Senate would determine who gets tax credits to help buy insurance by income, rather than age. And the Senate bill would take more time to phase out the ACA’s expansion of Medicaid coverage; despite claims that this represents “heart,” it may have less to do with compassion than skewing how the bill is scored by the Congressional Budget Office. This pig’s lipstick is being applied with a trowel.

Ultimately, however, the impact is the same: sacrificing Medicaid for tax cuts. Majority Leader Mitch McConnell had the bill drafted in strict secrecy and hopes to ram it through as early as next week. The ACA, by contrast, was drafted over the course of a year, with more than 100 public hearings.

Does McConnell have the votes? Wavering senators should know that we’re not fooled. We see exactly what you’re doing — and you should expect to be held fully accountable.

Eugene Robinson’s email address is eugenerobinson@washpost.com.