Paul Ryan on TrumpCare: "This is who we are; this will come to define us."Earlier this morning we saw how the extremely cautious Cook Report has just downgraded the chances for Republicans to hold 20 congressional districts across the country. That isn’t normal behavior for Cook; they always tend to give incumbents every benefit of every doubt… every time. But the TrumpCare vote Thursday was a political earthquake and the rumblings are just beginning. Paul Waldman’s OpEd in yesterday’s Washington Post, Every Republican who voted for this abomination must be held accountable, is reverberating in dozens of congressional districts held by Republicans— including in places where Trump won, like Ohio, Michigan, Pennsylvania… even Texas! “I won’t mince words,” he wrote. “The health-care bill that the House of Representatives passed this afternoon, in an incredibly narrow 217-to-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 can’t recall what it might have been. And every member of the House who voted for it must be held accountable.” The DCCC is probably taking credit for their own “brilliant strategery.”
There’s certainly a process critique one can make about this bill. We might focus on the fact that Republicans are 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 the fact that they are 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 might talk about how every major stakeholder group— the American Medical Association, the American Hospital Association, the AARP, 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 10 years.• Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meager 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 ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.• Allows states to seek waivers from the ACA’s requirement that insurance plans include essential benefits for things such as emergency services, hospitalization, mental health care, preventive care, maternity care, and substance abuse treatment.• Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.• Produces higher deductibles for patients.• Allows states to try to waive the ACA’s requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.• Shunts those with preexisting 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 can’t cover the population they’re 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’ll have to document every condition or ailment you’ve 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, don’t go to the doctor, and wind up finding out too late that they’re sick. People whose serious conditions put them up against lifetime limits or render them unable to afford what’s on offer in the high-risk pools, and 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 health-care bill is an act of monstrous cruelty. It should stain those who supported it to the end of their days.
Andrew Sullivan-- I thought he was a Republican-- had similar ideas about how TrumpCare is further destroying the Republican brand. He sees Obamacare more clearly than deranged congressional Republicans do-- as "an effective marriage of conservative principles and, well, human decency... [T]he concept of insurance is not socialism; it’s a matter simply of pooling risk as widely as possible. If any European conservative party were to propose such a system [as TrumpCare], it would be pilloried as a far-right plot. And yet the Republican Party opposed it with a passion that became very hard for me to disentangle from hatred of Obama himself."
The Trump GOP’s attempt to abolish it is therefore, to my mind, neither conservative nor decent. It’s reactionary and callous. Its effective abandonment of 95 percent of us with preexisting conditions will strike real terror in a lot of people’s hearts. Its gutting of Medicaid will force millions of the poor to lose health care almost altogether. It will bankrupt the struggling members of the working and middle classes who find themselves in a serious health crisis. It could hurt Republicans in the midterms-- though that will be cold comfort for the countless forced into penury or sickness because of Trump’s desire for a "win." But it’s clarifying for me. It forces me to back a Democratic Party I don’t particularly care for. And it destroys any notion I might have had that American conservatism gives a damn about the vulnerable. It really is a deal-breaker for me. I hope many others feel exactly the same way.
A word of warning the people excited enough to contribute to candidates: contribute to candidates, not to hucksters and scammers looking to get rich off this. There are old groups and new groups who will hit you up for money to help this candidate or that candidate or a group of candidates and maybe they’re legit and maybe they’re partially legit— and maybe they’re not. My suggestion— always give to the candidates’ campaigns directly, never to groups promising to pass the money— most likely, some small portion of the money— along. Candidates have contribution buttons on their websites or you can always go to an ActBlue page and give to the candidates you want to help. If you want vetted candidates, DFA, PCCC, and several other groups do that. And so does Blue America. This thermometer on the right will take you to a page with congressional candidates, who are certified progressives and of good character. See if there are any you would like to help defeat the Republicans who voted for TrumpCare Thursday.