Republicans could destroy Obamacare while spotlight is on Russia scandal

Paul Krugman: The US senate Bill is every bit as cruel and grotesque as its critics say

Healthcare protest: a rally outside the US Capitol, in Washington, DC. Photograph: Saul Loeb/AFP/Getty

Healthcare protest: a rally outside the US Capitol, in Washington, DC. Photograph: Saul Loeb/AFP/Getty

 

Will Republicans in the United States Senate try to destroy healthcare under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House of Representatives earlier this year.

Back in March attempts to repeal and replace the Affordable Care Act, aka Obamacare, seemed dead after the Congressional Budget Office released a devastating assessment, concluding that the house Republican Bill would lead to 23 million more uninsured Americans. Faced with intense media scrutiny and an outpouring of public opposition, house leaders pulled their Bill, and the debate seemed over.

But then media attention moved on to presidential tweets and other outrages – and, with the spotlight off, house leaders bullied and bribed enough holdouts to narrowly pass a Bill after all. Could something similar happen in the senate?

A few days ago the senate’s equally awful version of repeal and replace – which the CBO says would leave an extra 22 million people uninsured – seemed dead. And media attention has visibly shifted off the subject, focusing on juicier topics, such as the Russia-Trump story.

This shift in focus is understandable. After all, there is growing evidence that members of the Trump inner circle did indeed collude with Russia during last year’s US presidential election; meanwhile, Trump’s statements and tweets strongly suggest that he’s willing both to abuse his pardon power and to fire Robert Mueller, the special counsel looking into Russian interference, so provoking a constitutional crisis, rather than allow investigation into this scandal to proceed.

On Saturday the tweeter-in-chief, breaking long-established rules of decorum, called on the audience at a military ceremony to pressure the senate to pass the Bill

But while these developments dominate the news, neither Mitch McConnell, the majority leader in the senate, nor the White House has given up trying to deprive millions of healthcare. In fact on Saturday the tweeter-in-chief, once again breaking long-established rules of decorum, called on the audience at a military ceremony, the commissioning of a new aircraft carrier, to pressure the senate to pass that Bill.

This has many people I know worried that we may see a repeat of what happened in the spring: with the media spotlight shining elsewhere, the usual suspects may ram a horrible Bill through. And the House of Representatives would quickly pass whatever the senate comes up with. So this is actually a moment of great risk.

One particular concern is that the latest round of falsehoods about healthcare, combined with the defamation of the CBO, may be gaining some political traction. At this point the more or less official Republican Party line is that the budget office – whose director, by the way, was picked by the Republicans themselves – can’t be trusted. (This attack provoked an open letter of protest signed by every former CBO director, Republicans and Democrats alike.)

In particular, the claim is that its prediction of huge losses in coverage is outlandish and that, to the extent that fewer people would be covered, it would be due to their voluntary choices.

In reality those CBO predictions of coverage losses are totally reasonable, given the senate Bill’s drastic cuts to Medicaid: 26 per cent by 2026, and even deeper in the next decade. You have to wonder how someone like Senator Shelley Moore Capito, of West Virginia, could even consider supporting this Bill when 34 per cent of her nonelderly constituents are on Medicaid. The same goes for Senator Jeff Flake of Arizona, where the corresponding number is 29 per cent.

The senate Bill would degrade the quality of subsidised private insurance, leading to a huge rise in deductibles – the excess that the policyholder has to pay

And on those claims that it’s okay if people drop coverage, because that would be their own choice: it’s crucial to realise that the senate Bill would degrade the quality of subsidised private insurance, leading to a huge rise in deductibles – the excess that the policyholder has to pay.

Current law provides enough in subsidies that an individual with an income of $26,500, or about €23,000, can afford a plan covering 70 per cent of medical expenses, which, the CBO estimates, implies a deductible of $800, or about $700.

The senate Bill reduces that standard of coverage to 58 per cent, which would raise the implied deductible to $13,000, or about €11,400, making the insurance effectively useless. Would deciding not to buy that useless insurance really be a “choice”?

By the way, remember when Republicans like Paul Ryan used to denounce Obamacare because the insurance policies it offered had high deductibles? It’s hypocrisy all the way down. In short, the senate Bill is every bit as cruel and grotesque as its critics say.

We mustn’t let Russian interference, the mother of all scandals, take up all our mental bandwidth: healthcare for millions is also on the line

But we need to keep reminding wavering senators and their constituents of that fact, lest they be snowed by a blizzard of lies. I’m not saying that everyone should ignore Trump-Putin treason and all its ramifications: clearly, the fate of our democracy is on the line. But we mustn’t let this mother of all scandals take up all our mental bandwidth: healthcare for millions is also on the line.

And while ordinary citizens can’t yet do much about the looming constitutional crisis, their calls, letters and protests can still make all the difference on healthcare. Don’t let the bad guys in the senate do terrible things because you weren’t paying attention!

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