The Closer You Look, The Meaner It Is

If your eyes glaze over at the prospect of getting down “in the weeds” of the Senate healthcare bill, Josh Marshall’s summary really tells you everything you need to know:

It has always been crystal clear for numerous reasons that the Senate health care repeal bill would be the like the House bill, both versions, just as it will be like the final bill that emerges from a conference committee. McConnell and Ryan knew that ball hiding about scores and legislative language would prevent reporters from saying this: Around 24 million Americans will lose their coverage, everyone will go back to the era of pre-existing conditions restrictions and lifetime limits. The freed up money will go to a big tax cut for the very wealthy. You didn’t need to see the legislative language to know this. It’s been a failure of journalism to pretend otherwise.

If, however, you want several specific compelling reasons to oppose this travesty, there are any number of reports and commentaries that can help. For example, we learn about several “buried” provisions from an article in the LA Times, in a column that describes the bill as a “poorly-disguised massive tax cut for the wealthy, paid for by cutting Medicaid — which serves the middle class and the poor — to the bone.” Then there’s this:

States will have more authority to reimpose lifetime and annual benefit caps and eliminate essential health benefits. This may be the most insidious provision of the repeal bill, and certainly is the most deeply hidden.

As several Governors–including Republican Governors– have noted, this grant of authority to the states will almost certainly be used, because the deep cuts in Medicaid and other federal funding will leave the states no choice.

The Affordable Care Act also had state waivers designed to allow for innovations, especially in state Medicaid programs. But under the ACA, those waivers could not  lead to fewer people being insured, or to the imposition of higher out-of-pocket expenses. The Senate bill repeals those limitations.

Under the measure, the secretary “must” approve a waiver request as long as it won’t increase the federal deficit. As a result, states would be able to eliminate the essential health benefits that all health plans must provide under the ACA — including hospitalization, prescription coverage, maternity care and substance abuse and mental health treatment. Since only essential health benefits are subject to the ban on lifetime and annual benefit limits, high-cost patients such as cancer victims and sufferers from chronic diseases could permanently lose their benefits in the course of their treatment.

And then there’s pre-existing conditions. As the Times reports,

Protection for people with preexisting conditions is destroyed. Senate Republicans claim in their talking points that the measure protects people with preexisting conditions from being denied coverage or priced out of the market. Don’t believe them…The Senate bill will open the door to states forcing people with preexisting conditions into segregated markets that will lead them to pay far, far higher costs than everyone else….This bill will bring the country back to a system in which insurance only works for the healthy, and the sick can’t afford the coverage they need.

There’s lots more. Older Americans will get hosed; under this bill as currently drafted, older Americans could be charged five times what younger, healthier Americans will pay. Meanwhile, the biggest tax cut for the rich is retroactive; a millionaire who already had booked a $1-million gain on a stock sale, for example, would collect a $38,000 benefit.(Even the Wall Street Journal was aghast at that one.)

And most despicable of all:

In fact, all the measure’s tax cuts taken together, valued at about $700 billion over 10 years, would be almost entirely paid for by the bill’s elimination of Medicaid expansion in the 30 states and the District of Columbia that accepted it.

The bill defunds Planned Parenthood. It cuts Medicaid so drastically that hundreds of thousands of elderly Americans will no longer be able to go to nursing homes, and rural hospitals that depend upon Medicaid will close. It will strip coverage from more than twenty million people, and take us back to the days when people had no choice but to use emergency rooms for primary care. The medical cost curve, which had been coming down under the ACA will once again rise more rapidly than the rate of inflation.

And why? To further enrich the already wealthy–and not so incidentally, to destroy the legacy of America’s first black President.


  1. They are not Lincoln Republicans, they are draconian carpetbaggers.
    A pox on both….

  2. Thanks Prof K. Here we have the true Republican party on display. Awful people. Just awful.

  3. History will adios many of them in 2018 and the rest in 2020. The swamp will be drained of the muck, dreck, mire and bloat farts. Global warming will be alleviated. But don’t depend on it; VOTE!!

  4. Marge; the protests against the current administration should NEVER stop if we hope to survive the Republican 1% determination to destroy us.

    Some Republicans are speaking the truth when they admit wanting to pass Trumpcare only to delete the “Obamacare” (a misnomer) sections from the ACA. That is their only reason and their only goal for their rush to pass their unhealthy version of a health care (another misnomer) bill. They are into quantity (much of their bill is tax cuts for the wealthy having nothing to do with health care) and speedy action, rushing through Trump’s campaign “promise”, a disguised threat against the middle and lower income Americans. Don’t lose sight of the fact that SCOTUS is hearing Trump’s anti-immigration ban at this time. He is waging battle on two fronts this week to push through two of his inhumane bills to give the Republican Congress something to celebrate over the July 4th weekend. If they succeed; it will only be a celebration for the freedom of the 1% and the denial of the meaning of Independence Day; the July 4th celebration of freedom of America and Americans.

  5. “Can it really be that salaried professionals – managers, professors, judges – have replaced the super-rich in the popular imagination as “enemies of the people”? It seems so. The Trump family penthouse at the top of Trump Tower has more gilt than any Vanderbilt could have imagined – it must be like living inside an ingot – but the poor among Trump’s supporters don’t seem to mind. A rich man who might once have been the cause of public disaffection has now become its political consequence.”

  6. Basically, they want to punish WE THE PEOPLE for electing a “black” President TWICE.

  7. This bill was written specifically to make policy-wonks’ heads explode.

    I just read a short article on Vox which cites a some cryptic language in the bill which affects small employer health plans in that it CREATES a new department in HHS to TAKE AWAY oversight of this segment from the states. Although its implications are not entirely clear, the idea is to allow small employers to go back to accessing plans through employer associations. In the past this practice often led to plans being offered with low premiums but covered very little ($50 per day hospital benefit! lol). The new HHS dept is to ensure these plans are not approved for sale, however, like other provisions of the bill, it will likely lead to segregation in the small employer market and employers with a younger/healthier workforce will reap rewards but those with older and sicker employees will see their premiums rise. A lot.

    I still believe an unintended consequence of the bill very well could be the destabilization of the entire employer-sponsored health insurance market (where 150 million Americans get their coverage), mainly in two ways: 1) the segregation of the market into winners and losers described above and in many other analyses of the bill, and 2) the sudden reduction of coverage of 24 million Americans and the need for health providers (esp small-town rural hospitals) will desperately need to recover lost revenue by : 1) reducing costs through curtailing services, service quality, or just closing hospitals, 2) demanding higher reimbursement rates from insurance companies for all remaining insured patients. This could create even greater disparity between private insurance reimbursement rates from those of Medicare and Medicaid, further incenting physician practices from accepting Medicaid patients (or capping them as a % of their patient-load).

    Perhaps it’s all just wishful thinking on my part – because if it plays out Republicans will roll-out Medicare-for-all faster than you can say “repeal and replace”.

  8. To repeat something I posted on my FB page:
    This Republican “healthcare” bill reveals how morally, ethically and spiritually bankrupt they are.

  9. I spent the 14 years of the last 18 years of my life working with families of children with special needs and family advocate. What these fiends are proposing will be especially devastating to nearly all of them, not to mention the elderly and the poor in general. That anyone in their right mind would think what is being proposed is acceptable, fair and not cruel, is beyond me. When Bernie Sanders says that people will die as a result of this bill and its implementation he isn’t kidding. I, personally, can think of some real people, small ones that I know personally, that will be smack dab in the middle of the crosshairs as a result of this heinous act.

    We need to like an army, like the one that defeated Nazi Germany, and drive these “people” out of power as well as those that pull their strings like the Koch brothers. That our elected representatives would do this astronomically sized killer bait and switch on the American people is totally shameful.

  10. We need a genuine healthcare debate…

    “Point being, in the “healthcare-vs-let-em-die” debate, there would be two legitimate sides. But in our current healthcare debate, we first have Obamacare: a pro-corporate system designed to enrich an industry made of slimy parasites who spend their days trying to figure out how to make sure people either owe them lots of money or die quickly. Then we have Trumpcare: a pro-corporate system designed to enrich an industry made of slimy parasites who spend their days trying to figure out how to make sure people either owe them lots of money or die quickly. …BUT with one of those options there are no pre-existing conditions. (Except for the pre-existing condition of national psychosis which acts like this is a genuine debate.)”

  11. Under the ACA I was able to obtain health insurance. I was uninsured for almost five years before that and have permanent health damage because I was unable to afford care/ surgery that I needed. Without the ACA I will return to having no health insurance. The republicans most definitely want to kill millions of their fellow citizens.

  12. Also…..This map compares county-level projections of premiums and tax credits for marketplace enrollees under the Affordable Care Act (ACA) in 2020 with estimates for the Better Care Reconciliation Act (BCRA) as unveiled June 22 by Senate Republicans. Our maps comparing premiums and tax credits under the ACA and the American Health Care Act (AHCA) passed through the House are here.

    This map includes premium and tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $60,000, $75,000, $100,000, or 351% of the federal poverty level (which is just above the cutoff for tax credits under the BCRA). The map includes estimates for premiums, tax credits, and premiums after tax credits for bronze and silver plans in each county in 2020.

    Good thing the Democrat leadership, after months of preparation, laid such careful groundwork to counter Republican talking points. Oh, wait… That was the opportunity cost of a solid six months of wall-to-wall Putin Derangement Syndrome, wasn’t it? Well played.

  13. I think it’s important to add that the tax cuts for the rich go into effect immediately, while the cuts to Medicaid that will pay for the tax cuts are phased in over time starting in 4 years. So we will spend money that we don’t have and may, in fact, never have. John Cassidy’s recent article in The New Yorker lays it out and is a must-read.

  14. The head of Americans for Prosperity ( The Koch bros’ most well known “nonprofit”) said they are ready to spend at least $400 million on just the 2018 elections alone.

  15. During the time that the ACA was being written, with the public being informed of sections of the bill prior to passage, people were still listening to Sarah Palin’s every word as gospel. She referred to one section of the bill as Obama’s Death Squad; that doctors would decide which old people would live and which would die. It was a very simply written, easy to understand section allowing patients to schedule an appointment with their physician to decide THEIR “end of life decisions”; meaning did they want to be kept alive (possibly for years) on machines or with imminent death approaching, no heroic measures were to be taken. This appointment would be covered as their medical examinations are covered by their insurance carrier. The Democrats caved and Sarah won; leaving unknowing Americans with the belief that it was an actual “death squad”. This discussion can be held during a medical examination or, as I resolved it, by setting up the order legally and giving my physician copies of the documents during a medical appointment.

    Well; nothing from Sarah Palin these days about the full Republican administration and Congress, all members of Trump’s blatant actual Death Squad paid for with our tax dollars; his “mean” unhealthy health care bill being rushed through the system to enact before July 4th as “keeping his campaign promise”.

    Happy Independence Day, America! Enjoy your July 4th weekend safely and in good health.

  16. How did we get here?

    “As a result they took the economic issues off the table that used to win again and again in the thirties and forties for the Democrats. The labor issues, the living wage issues, the health insurance issue, pension issues. And that of course was a huge bonanza for the Republican Party because the Republican Party could not contend on economic issues. They contended on racial issues, on bigotry issues, and that’s how they began to take control of the solid Democratic South after the civil rights laws were passed.”

  17. In case you didn’t see it, the Koch brother’s little army of billionaires is preparting to spend $400 billion on the 2018 elections . Their goal is to nail down their positions in the several states and increase their majority in the Senate. “Fasten your seat belts. It’s going to be a bumpy ride.” VOTE!

  18. Make that million, rather than billion. Even the Kochs can’t afford $400 billion. Sorry.

  19. Protests help people feel like they are doing something, connect them with like-minded folks, and help keep a topic in the spotlight.

    However unless those protests turn into votes (in every election), turn into getting involved in political parties, and turn into running for offices (at all levels) the protests can’t create political change.

    Getting involved doesn’t mean giving up your life. In one to two hours a week you could become a vital part of your local, county, state, and national political structures. Which is what a healthy democracy requires.

    Collectively we got lazier and lazier and we pay that. Each citizen has to do their part or democracy is doomed.

  20. Stopping the passage and implementation of Trump Care will not be enough… not by a long shot. If Trump Care is defeated, we will then be left with Obama Care and all of its problems, none of which the Republicans will even attempt to correct. In fact, they will continue to eat away at Obama Care causing more problems for the poor and elderly. What to do? What to do?

    We have one and a half years to elect a super majority in the Senate and take the House.

  21. This healthcare legislation makes me so angry I can barely contain myself. It is so obvious that all of these wealthy, old, white men intend to insure the death of people that are not wealthy, old or white. I can only think of how this will impact my son who has epilepsy and his ability to purchase his anti-seizure medication which would cost $574 per month without insurance. His medication gives him the ability to work and live a life without the fear of a seizure without warning. No medication and he returns to the near constant threat of a seizure that would keep him from driving, working or just being able to live on his own. I think about how this will impact my 87 year old mother when she needs to go into a nursing home and we have exhausted all of her financial assets and medicare benefits and we have no other resources to provide her with care. And next month when I go back to my classroom I will look at all of those precious little faces and wonder how many of them go without much needed medication so that some wealthy, old, white guy can get a tax break.

    Politics over people. Disgusting.

  22. The perils of Democrat identity politics are surfacing in the established LGBT community where subgroups are claiming discrimination. Apparently, there’s too much emphasis placed on the experiences of gay white men and the leadership of the LGBT community is too white.

    Party unity is next to impossible when the Party is divided into special identities. “United we stand, divided we fall.”

  23. As I have written before, the Republican version of a healthcare bill is not healthcare bill; it is a massive tax reduction bill for the rich and corporate class. The health component is just the means by which tea partiers insist on curbing the deficit – someday – an inhuman expense to the rest of us. This bill is a killer bill, and I am not exaggerating. Any senator of any party who votes for this is on my (political) hit list. GRRR!

  24. As a senior with Medicare, I have wondered where this will hit me. Well, as I age and my body becomes more non-functional, I am likely to end up in a Nursing facility. Although I am using my savings (for retirement travel and fun) to pay my annual Long Term Care Policy Premiums, about my 5% draw each year, I realize that once in a facility, my “spending down of assets” will happen very rapidly, and the three years under my LTC Policy could extend into many more. What then, why Medicaid of course. However if it is time limited, and not available, guess they will just have to let me die there or elsewhere. When we think it might not touch us, think again. If not you, perhaps your parents, relatives, kids, grandkids. This is not what lead to a sense of health care mental security.

    Think again of Senator Claire McCaskill’s idea of perhaps all of us covered under the Congressional Health Care Marketplace Plan. Why would all those Congress people mind? Perhaps that is the answer, we move into their neighborhood, or their backyards.

  25. William excellent link @ 8:22 am to the Intercept Article. California which appeared to be advancing a Single Payer system, suddenly has had the rug pulled out from underneath that effort. By guess who a Democrat!!!!!! Assembly Speaker Anthony Rendon, a Democrat, announced he was pulling the bill from further consideration this year.

    Known as the Healthy California Act, or SB 562, the measure had already passed the state Senate and was making its way through the lower chamber when Rendon said Friday it was being shelved by the Assembly Rules Committee, which he chairs, “until further notice.”

    So as usual in the Corporate Democratic Party they find someone to pull Defeat from the Jaws of Victory. The Republicans have for years been yapping about Repeal and Replace ACA (Obama Care). Now, they may get their wish.

    The Corporate Democrats, and their shills in the Media are absorbed by Russia and Trump, and stamping any Progressive movement within the Party out. The dwindling Corporate Democratic Party is gathering up on the hill, their only hope is the Republicans decide they are so harmless, they will be bypassed in any future election.

  26. I have two questions, unanswerable at this time, but answers will be needed if Trumpcare passes. The answer is PROBABLY obvious with loss of preexisting condition coverage for new policy holders.

    Some members of my daughter-in-law’s family carry the breast cancer gene; will genetics be considered preexisting condition even if not an issue when a policy is issued?

    People currently being covered for a preexisting condition who opt to maintain their current coverage, will that coverage be denied to continue?

    The possible/probable listing of preexisting conditions we have seen which will not be covered leaves possibly…oh, never mind, it doesn’t appear to leave anything to be covered.

  27. Many of these comments could be summarized as oligarchy will replace democracy once mass media pervades over education and wealth re-distribution reaches a certain level.

    We are on auto-pilot now that those conditions have been reached. No country has been here before. As America led the way to practical democracy so will America lead the way to the end of democracy as the cost of buying votes and politicians is now lower than the expected returns. Those who view monetary measures as the whole picture of life are as much on auto pilot as the rest of us.

    Now we reached the end of sustainable democracy at the same time as the end of sustainable energy (politically not technology wise) and progress which all lead to the end of a sustainable economy.

    Hunker down and wait to see what rises from the ashes.

  28. JoAnn, of course preexisting conditions will be covered….. your premiums, however, will be astronomically unaffordable. End of PR problem facing Republicans.

  29. You said everything well, but there is other fallout: people who might otherwise think of changing jobs or getting divorced or married would balk at doing so, if pre-existing conditions aren’t covered. For example, if you have chronic conditions such as arthritis, asthma or diabetes, or if someone you were thinking of marrying had such conditions, if you currently have health insurance through your employer or via your current spouse you no longer want to be married to, you could lose coverage if insurers could refuse you or charge you unreasonable premiums you can’t afford. Being able to have affordable health care touches many aspects of people’s lives, not just health.

  30. The bottom line is that health insurance should have never been tied to employment. If tax deductions were eliminated for employers who provide health insurance, you can be assured that they would drop employee health insurance coverage immediately.

    Our entire system is extremely unfair. The people with low paying jobs and no benefits at all are still forced to pay taxes to make up for the taxes not paid by corporations and their employees due to paying health insurance premiums pre-tax.

    Whatever the outcome of the vote by Rs in this insurance debacle, I sincerely hope this has created enough fear in the majority of citizens to move us more rapidly towards single payer health insurance.

  31. Elephant alert! Elephant alert! The rumor mill has it that the Republican controlled U.S. Senate is now being professionally educated by our current fake president and Alaska’s former fake governor. They’ve created the Trump/Palin Health Plan that will make it possible for Americans to live almost as long as they think they’ll live. The Republicans will not have the slightest idea what the plan is all about, but how does that differ from the way the situation is right now?

  32. This is the most depressing and hopeless picture of our beloved country ever. It is hard to carry on in the face of this.

  33. Under AHCA, nearly 540,000 people will die in the next decade because of lack of health insurance coverage. For Obamacare, it is a more respectable 320,000 deaths.

    In other words, what we have in this week’s battle is a struggle between the two major parties about how efficiently to implement Rule 2 of Neoliberalism(Go Die). I’m waiting for the liberal Democrat explanation of why 540,000 deaths are bad, but 320,000 deaths are jake with the angels, when there’s a 0-deaths alternative available. Until we get one, liberal Democrats have no standing for virtue signaling whatever.[1] All the liberal Democrats want to do is hit you with a softer hammer.

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