Jay Bookman

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

Opinion: The Senate health-care bill is a gross betrayal

I can't figure out why Republican senators worked so hard to keep their health-care proposal secret for so long, since it turns out to so closely mirror the House version.

Certainly, the bottom line is the same:

Both bills cut $800 billion in funding for Medicaid  -- much of which covers health care for poor children, for the disabled and for the elderly in nursing homes. Through tax cuts, both bills then smuggle that $800 billion to those who are deemed much more in need.

You know, those in the top 1 percent of income, those who have already benefited enormously from this economy, those whom President Trump sneeringly derides as the elite even as he and his party alter the structure of government and the economy to further enrich that very same elite.

The Senate bill should also silence those who tried to argue that Republican policy shouldn't be judged on the Republican bill that passed the Republican House and that Republicans went to the White House to celebrate with our Republican president. That bill was so bad that even Donald Trump complained later that it was too mean, that it lacked "heart."

Well, the Senate bill is just as mean, except in a few slightly different ways.

Let's be clear about what's at stake here:

Medicaid pays the bill for roughly two-thirds of Americans in long-term nursing home care. In Georgia it pays for 74 percent of that care. Medicaid pays the health-care bills for almost 40 percent of America's children. In Georgia, it's 45 percent. And as Health and Human Services Secretary Tom Price likes to point out, a lot of doctors won't even accept Medicaid these days, although Price never mentions why.

It's because Medicaid reimbursement rates are so low. So what happens to those rates when $800 billion in federal funding disappears? How many doctors will take it then?

In a letter this week to Senate leaders, the chief executives of some of the largest managed-care providers in the country pointed out another important consequence:

“In 2015, more than 2 million Americans had an opioid use disorder. Nationally in 2016, Medicaid paid for 24 percent of the medications that are used for treating opioid addiction. In the five states with the highest opioid overdose mortality rates (West Virginia, New Hampshire, Kentucky, Ohio and Rhode Island) Medicaid covered 41 percent of opioid treatments. Cutting Medicaid coverage will only worsen the opioid crisis.” (Emphasis original.)

Look at those five states hit hardest by the opioid crisis. One is Kentucky, the home state of Senate Majority Leader Mitch McConnell. As one gauge of the severity of the problem in Kentucky, emergency responders in the capital of Louisville, a city of 766,000, dealt with 151 emergency overdose calls in just a four-day period recently. It's a terrible situation, but it would be much worse without Obamacare and Medicaid expansion, which have cut the uninsured rate in Kentucky from 20.4 percent in 2013 to 7.8 percent in 2016, the largest reduction in the country.

In New Hampshire, candidate Trump made sweeping, seemingly heart-felt promises that he would get help for those caught in the epidemic. "We’re going to set up programs," he promised voters. "We’re going to try everything we can to get them unaddicted.”

In Ohio, which was key to Trump's election,  he made similar promises.

"We’re going to take all of these kids—and people, not just kids—that are totally addicted and they can’t break it,” he told a town hall meeting in Columbus back in August. “We’re going to work with them, we’re going to spend the money, we’re gonna get that habit broken.”

As political strategy, it was brilliant. In the industrial Midwest, where Trump in essence won his victory, 95 percent of the counties where he outperformed Mitt Romney also had higher than average rates of drug mortality.

And this is the thanks they get. Instead of spending more money, Trump and his fellow Republicans are slashing those programs. In addition to drastic Medicaid cuts, both the House and Senate bills would strip the requirement that private health-care plans cover addiction treatment.¹

If these cuts are enacted, if Republicans "succeed," then people will die who otherwise might be saved. Maybe a lot of them. I've been to funerals of young people -- children, really -- who couldn't shake this addiction. One was for a young girl whom I coached in soccer for a decade. I've also seen friends, and neighbors, and children of friends and neighbors succumb to it, and I don't live in the rural communities and small towns where its impact is greatest, and where government-funded addiction programs are really the only option.²

Now, the very people who promised to help those communities are in the process of stripping them of both help and hope, and using deception, secrecy and betrayal to do so, all in the service of tax cuts for the already wealthy. There's a lot of anger out there in the political process, but you look at things like this and you realize that maybe there's not as much as there ought to be, as there needs to be.


¹Initially, the Trump budget for 2018 also proposed cutting the lead federal anti-drug agency, the Office of National Drug Control Policy, by 95 percent, and the Pennsylvania congressman initially tabbed to head the office withdrew from consideration. The administration reversed those proposed cuts only after being shamed by a public backlash, but it has yet to nominate a new director for the office.

² The Senate bill does contain a one-time, $2 billion appropriation for 2018 to help combat the opioid epidemic. However, as noted by U.S. Sen. Shelley Moore Capito, R-WV, that sop doesn't begin to offset the loss of Medicaid funding for addiction treatment and is only a one-time expenditure.


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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.