Jay Bookman

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

Opinion: It's a matter of priorities, wealth over health

Remember, it’s about the money.

It’s always, always about the money.

For example, Republicans have no real idea about how or even if they’re going to replace Obamacare. But one thing they know: They’re going to repeal surtaxes on the richest of Americans that have helped finance health insurance for an additional 20 million Americans.

That, they’ve made a priority.

As a result of that tax cut alone, the 400 richest households in America will receive an estimated $2.8 billion increase in annual income. Those with incomes of a million dollars or more would enjoy an average tax cut of almost $50,000, which is roughly the total income for the median American household.

Individuals making less than $200,000 and couples making less than $250,000 would get no tax break at all.

And of course, that’s barely the beginning. In addition to dismantling Obamacare, Republicans are targeting traditional Medicaid for significant cuts. A proposal by U.S. Rep. Tom Price of Georgia, nominated to be secretary of health and human services, would cut Medicaid funding by more than $1 trillion over the next decade by converting it to a so-called “block grant” program.

Right now, if you need Medicaid, you get it. If you or your child or your elderly parent in a nursing home meet the income eligibility standards for Medicaid coverage, you get that coverage. (Medicaid funds roughly three-quarters of long-term nursing home care in Georgia.) Price and others want to rescind that promise.

They don’t tell you that, of course. Republicans sell the block-grant approach as a way to “return control to the states,” which sounds good to some people. But that’s a mask, a facade, used to disguise the true intent of their approach, which is to slash tens of billions of dollars from a program relied upon by tens of millions.

Here’s how it would work. A block grant by definition is a fixed amount of money. Congress would appropriate that fixed amount of money each year — an amount significantly less than what is currently spent — and then distribute those fixed amounts to the states, which would then decide how to spend it.

That in turn would set off a Darwinian competition for resources at the state level. In Georgia, roughly 2 million people rely on Medicaid for health coverage; 64 percent are children. If Medicaid is converted to a block grant program in which those block grants are reduced with each passing year, the needs of young schoolchildren with no other form of health insurance would be pitted against the needs of the elderly with no other means of paying for long-term care against the needs of poor adults in rural areas who also have no other coverage option. A lot of people, many of whom are Trump voters, are going to suffer.

The problem, conservatives explain, is that we just can’t afford it. We call ourselves the richest, most productive country in the world, yet we can’t afford what every other industrialized country somehow can afford.

But here’s the part that really gets me. Politicians who piously look you in the face and cite deficits as the reason that we can no longer help fellow Americans in need are the very same people aggressively, obsessively pushing tax cuts that will add trillions to those same deficits. According to the Tax Policy Center, for example, tax cuts proposed by Donald Trump will add $7 trillion to the debt over the next decade, with the richest 0.1 percent enjoying tax cuts averaging $1.1 million a year, on top of the Obamacare tax cuts.

We can afford that, but not Medicaid.

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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.