Jay Bookman

Opinion columnist and blogger with The Atlanta Journal-Constitution, specializing in foreign relations, environmental and technology-related issues

Opinion: GOP health plan an act of malice

"I firmly believe that nobody will be worse off financially in the process that we're going through," Health and Human Services Secretary Tom Price said Sunday, referring to the GOP plan to replace Obamacare. He also claimed that "in fact I believe, again, that we'll have more individuals covered."

I'm going to put this bluntly: If Price really does believe that, it makes him a fool. If he doesn't, it makes him a liar. And the truth is that he's probably some of both, having convinced himself that up really is down and black is really white and 2+2 can indeed add up to 5.53 as long as he keeps insisting it does.

For the rest of us, there's not much mystery here. The undeniable truth is that if the Republican plan becomes law, millions of lower and middle-income Americans will see their out-of-pocket expense for health insurance soar to several times their current levels. That's especially true for older Americans, and for those in rural areas and small towns. When you're making $25,000 or $30,000, an increase of $6,000 in your insurance premiums essentially prices you right out of the market, forcing you to go without coverage.

Our leaders also cannot slash Medicaid by trillions of dollars, as House Speaker Paul Ryan proudly bragged they are doing last week, and then plausibly pretend that nobody will be hurt by it and that in fact things will be better. Not when three-fourths of senior citizens in nursing homes here in Georgia depend on Medicaid to pay their medical bills. Not when Medicaid also covers 30 million low-income children nationwide and some 900,000 here in Georgia. Those are living, breathing and vulnerable human beings, our fellow Americans, and no matter how hard Price and Ryan pretend otherwise, those people are absolutely going to be hurt by this.

We're also hearing a lot of nonsense that this is what President Trump and his fellow Republicans were elected to do, that they are merely carrying out the mandate that voters have given them. Yes, they campaigned against Obamacare, or at least their cartoon version of it. Yes, they promised to "repeal and replace," although the debate became instantly nebulous once you sought the details of that replacement plan. At that point, Republicans retreated behind a rhetorical smokescreen involving phrases such as "cheaper" and "better" and "patient-centered" and my favorite of all, "more freedom."

Basically, voters were asked to take it on faith that the Republicans would be able to do much the same thing as Obamacare did, yet somehow better. Many believed it.¹ As recently as January, then President-elect Trump was still promising that "we're going to have insurance for everybody."

"There was a philosophy in some circles that if you can't pay for it, you don't get it,"  he told the Washington Post. "That's not going to happen with us. .... [They] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better."

But of course, there never was such a plan, and there could never be such a plan. In fact, here's the Republicans' dirty little secret: The predicted loss of insurance for as many as 15 million Americans does not represent a failure to them; it is not a regrettable side effect of the reforms that they hope to enact.

It IS the reform that they hope to enact.

All along, their real replacement plan for Obamacare has been to have no replacement at all, and the current bill comes as close to that goal as is politically plausible. It allows them to offer the illusion of continued coverage, without actually doing so. It allows them to cut all those Americans loose, creating room in the budget to offer major tax cuts for wealthier Americans. And because they don't like to think of themselves as cruel, they have convinced themselves, against all available evidence, that pushing millions of  Americans into the ranks of the uninsured will somehow make their lives better.

Ryan calls it "an act of mercy," but an act of malice is more accurate.

¹ According to an analysis by the New York Times' Upshot column, "The voters hit the hardest — eligible for at least $5,000 less in tax credits under the Republican plan — supported Mr. Trump by a margin of 59 percent to 36 percent."



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About the Author

Jay Bookman writes about government and politics, with an occasional foray into other aspects of life as time, space and opportunity allow.