If there is among you anyone in need, a member of your community in any of your towns within the land that the Lord your God is giving you, do not be hard-hearted or tight-fisted toward your needy neighbor. You should rather open your hand, willingly lending enough to meet the need, whatever it may be. Be careful that you do not entertain a mean thought, thinking, “The seventh year, the year of remission, is near,” and therefore view your needy neighbor with hostility and give nothing; your neighbor might cry to the Lord against you, and you would incur guilt. Give liberally and be ungrudging when you do so, for on this account the Lord your God will bless you in all your work and in all that you undertake. Since there will never cease to be some in need on the earth, I therefore command you, “Open your hand to the poor and needy neighbor in your land.”
The CBO had not yet scored the AHCA at the time of this post’s writing. Now they have, and you can check out the full text here.
The most damning, immediate paragraph:
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
That’s 14 million more people uninsured than right now, and the number would kick up into the mid-20-millions by 2020 when the Medicaid expansion runs out.
Of course, the administration’s not sure whether it trusts the CBO:
— Bradd Jaffy (@BraddJaffy) March 13, 2017
There are a couple of things I want to look at in depth this week, and I’ll be breaking them out into separate posts to keep this from stretching to a full 6,000.
First up is:
The American Health Care Act (AHCA)
So, TrumpCare. Or maybe RyanCare. Or, as more than a few have pointed out, even better, Don’tCare or NoCare. The GOP finally made public the bill to repeal and replace the ACA that they’d been hiding from both other Congresspeople and the public since two weeks ago.
First things first. If you want to know how any new plan after ObamaCare is going to affect you and America at large, you’ve got to understand what ObamaCare is. That’s a tall order, but luckily there are a plethora of resources dedicated to helping you out. And Michael Goodwin’s very long comic from 2014 at economixcomix.com is probably the easiest and most straightforward to read. No joke (and his analysis of the new Trump/Ryan bill before the markup last week beats what I’ve written here on the details, if you’ve got the time).
The new bill, the AHCA, debuted to excoriating reviews from pretty much all sides. The American Medical Association, the American Nurses Association, the American Hospital Association, and much more important for Republicans, the American Association of Retired People, or AARP, came out against NoCare.
Why? Well, it wrecks some of the best (and depending on your perspective, only good) parts of ObamaCare.
In order to widen the risk pool and lower the cost of insurance generally, ObamaCare forced all Americans to either pay an ongoing series of income-scaled fines or purchase health insurance. Young, healthy people who might otherwise have gone uninsured would then purchase insurance and subsidize old, unhealthy people. In order to reduce the financial burden for those young people, the original ACA also provided generous tax credits for people making between 100 and 400% of the federal poverty line, which is $11,770-$47,080 for a single person and $24,250-$97,000 for a family of four.
Here’s Ezra Klein explaining that risk pool and ‘death spirals’.
Now, for people making between nothing and 138% of the federal poverty line, the ACA created new rules which allowed those people to get onto Medicaid. It was previously very difficult to get benefits through Medicaid, but the ACA provided federal cash to the states to allow them to greatly expand the program, allowing those people who in the past had never been able to afford insurance (and who passed massive costs onto the taxpayer through emergency room visits) to get covered and to get cost-saving preventative care for the first time. 
The AHCA reduces the subsidies (tax credits) to $2,000 a year for young people and $4,000 a year for old people. Those flat rates fall below what anybody receives in most places, but if you’re in doubt, Kaiser Family Health has put together a map that shows you how your subsidies will change under the AHCA. Of course, if you’re buying insurance right now, you can check your own numbers against those two. Standard and Poor’s predicts 10 million people will lose insurance under the new bill.
The GOP has been railing against the mandate as an untoward intrusion of big government since the passage of Obamacare, so now they have to do away with it, despite it being necessary for our mangled health-insurance system to work. So they’ve replaced it with a surcharge on premiums for people who have had interrupted coverage. Which leaves us with exactly the problem it’s meant to fix.
Obamacare penalizes you for being off insurance. Trumpcare will penalize you for getting on insurance. The young people who were reluctant to sign up for care under the ACA are now being discouraged (through loss of tax credits, the elimination of the fines, and the creation of this new fee) from getting on, until they get sick. Which means that the risk pool won’t get spread out and premiums will skyrocket both for the people who need insurance and for the young people who get sick and have to buy insurance at the markup.
And the new bill gets rid of the Medicaid expansion. That would be just about the most unpopular thing the GOP has ever done, so Paul Ryan’s made it so that the federal help for the Medicaid expansion dies out in 2020, pushing the poison pill into the future but doing nothing to ameliorate its effects. From Ryan Lizza at The New Yorker:
Many Republican governors accepted a generous offer of federal money to expand the Medicaid rolls in their states, and after seven years of using the funds they don’t want a disruptive reversal that would cause millions of people to lose health insurance. In the Senate, four Republicans wrote a letter yesterday demanding that some version of the Obama Administration’s Medicaid expansion be included in any repeal bill. Several Republican governors have been lobbying President Trump for the same thing. Ryan’s response was to leave the expansion in place until 2020, a decision that, like the tax credits, is already being attacked by the right as retaining a crucial element of Obamacare. Proponents of the Medicaid expansion see the deadline as creating a health-insurance time bomb that will detonate in a few years.
Interestingly enough, the bill’s also taking flack from the far right for being too much like Obamacare, in the way that it holds onto some tax credits, some neutered version of the individual mandate, and the Medicaid expansion for a couple of years. So if everyone hates it it’s worth asking:
Who is this bill for?
Well, in short, it’s for 90s-style Republican ideologues like Paul Ryan and the masters they serve.
That the bill is shorter (and apparently I mean this literally, see below) appeases people who are rabidly anti-government but without much concern for what that actually means:
That the bill would allow insurers to charge catastrophic rates and re-impose coverage limits is a handout to the industry that has been a major contributor to Paul Ryan (and much of the rest of the GOP) for years.
That the bill is effectively a tax break for the rich—$33,000 a year for the top 1% and $197,000 a year for the top .1%—is unsurprising, given that since Reagan’s day, the GOP has made it conservative gospel that massive tax breaks to the wealthy will somehow improve the economy. Either that’s true belief, which is what they peddle downward to their voters, or it has to do with the fact that the GOP is the party of the rich and that the average legislator in Washington has a net worth just at the threshold of the top 1%, or eight-I-shit-you-not-million-dollars-and-that’s-just-the-median.
The bill is emphatically not for the majority of Trump voters, who are, in what’s become an infuriating liberal meme, some of the biggest beneficiaries of Obamacare.
From a Guardian article:
Janice Phelps, a 60-year-old disabled factory worker in Evansville, Indiana, knows how expensive healthcare is.
Each month, shots for her severe asthma cost $3,000. Quarterly injections for knee pain cost $3,200. Medication for depression costs $900. She has had seven back surgeries, two shoulder surgeries, and two knee surgeries since 1985. The largest public health programs in America – Medicaid and Medicare, which aid the poor and the elderly – paid for nearly all of it.
Yet those programs are now threatened by the men she voted for: Donald Trumpand former Indiana governor Mike Pence.
“I’m all in favor of repealing it,” she said about Republicans’ push to do away with the Affordable Care Act (ACA), popularly known as Obamacare. But, she said, when you talk about cutting Medicaid: “I don’t agree with that at all.”
It’s not just some lady waving a “hands off my Medicare” sign at a Tea Party rally. From the Washington Post:
…those groups that stand to lose the most in subsidies to pay for health coverage on the individual market backed Trump:
Those who stand to lose more than $7,500 in subsidies went for Trump by 58-39.
Those who stand to lose between $5,000 and $7,500 went for Trump by 60-35.
Those who stand to lose between $2,500 and $5,000 went for Trump by 49-45.
Those who stand to lose between $1,000 and $2,500 went for Trump by 46-46.
And low-income whites that voted for Trump have always been some of the primary beneficiaries of Obamacare. Years and years of conservative propaganda have convinced them that somehow an ACA replacement will only target those other poor people, the undeserving ones, the ones who usually have browner skin. As MetaFilter user Stonewall Jackson pointed out in 2009 when the original Obamacare debate was raging:
Millions of Americans would rather die in the poorhouse than go to bed at night knowing that someone, somewhere is receiving something they helped pay for.
Well, almost eight years later, those same Americans elected the guy who might just push through the legislation that would rob them of their healthcare, their subsidies, and their Medicaid, right along with all those blacks and Hispanics and welfare queens.
In case anybody’s still got any illusions, though, here’s the President in his joint address speaking about healthcare:
The relevant portion, where he describes what any new plan must do:
First, we should ensure that Americans with preexisting conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges. (Applause.)
Secondly, we should help Americans purchase their own coverage through the use of tax credits and expanded Health Savings Accounts — but it must be the plan they want, not the plan forced on them by our government. (Applause.)
Thirdly, we should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out. (Applause.)
Fourth, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance, and work to bring down the artificially high price of drugs, and bring them down immediately. (Applause.)
And finally, the time has come to give Americans the freedom to purchase health insurance across state lines — (applause) — which will create a truly competitive national marketplace that will bring costs way down and provide far better care. So important.
What’s crucial to note about the new bill is that it doesn’t do any of that. There will be no stable transition for people who suddenly lose the tax subsidies that are the only things that let them afford care. The Republican framing is that Obamacare “forces” you to get healthcare, while any replacement bill will give you the “choice” to have it. But if you can’t afford it because of that same replacement bill, the government is 100% forcing you not to have healthcare.
The governors will indeed have all the help they need with the Medicaid expansion. Until 2020, when they’ll have none. And the bill does nothing to allow you to purchase insurance across state lines (which is useless anyway). Nobody except big pharma and the extremely wealthy win with this bill. Nobody likes it.
Which brings us to our last point:
If the Bill’s DOA, Why Does It Matter?
The AHCA does not include a provision to allow the purchase of insurance across state lines because that’s a policy change and this bill only makes budget changes. Why? Because the GOP wants to ram it through the congress with something called reconciliation, which you can only use for budget bills. Reconciliation would allow the Senate to pass the bill on for Trump’s signature with only a bare majority, or 51 votes, making an end-run around the filibuster.
You might know about reconciliation, because Republican congresspeople consistently cried foul whenever the Democrats brought it up as a way to escape unending GOP obstructionism under Obama.
In fact, the way that the GOP has managed the AHCA bill has been a thoroughly hypocritical exercise. The rightist narrative for the whole time the Obama administration was working on the ACA was that the Democrats were shoving this bill down Americans’ throats. That’s despite an entire year of debate on the ACA and several scorings by the Congressional Budget Office.
The House GOP pushed the bill through as quick as possible explicitly to avoid a CBO scoring that would point out that you can’t cut funding and provide more and better care to everyone at the same time.
They’re trying to do the same in the Senate, and although Democrats there have more power to delay the bill, the GOP is hell-bent on getting it passed, even though nobody outside their caucus, including their base, wants it to become a law. Which is why this supposedly dead on arrival bill matters.
Not only that, but CNN’s White House Correspondent Jim Acosta reported something even more ominous last week:
Trump told Tea Party groups at WH if GOP health care plan dies, he will let Obamacare fail and let Dems take the blame, I’m told.
— Jim Acosta (@Acosta) March 9, 2017
That is that even if this bill doesn’t pass, there’s a chance Trump will continue trying to hamstring the ACA with executive orders and then try to use its failure to tarnish the Dems. We said during the election that Trump was trying to weaponize suffering.
This is just the next logical step in that strategy. Destroy the health and livelihood of his base, count on conservative radio to lay the blame at the Democrats feet, and ride that wave of resentment to further victory.
I’d like to say that’s not a good plan, but given that the GOP has been getting its base to vote against its own economic interests at least since Reagan brought the evangelicals into the Big Tent, it’s far from a long shot.
In Slightly Lighter News, A Clown Car
Jason Chaffetz, the ratfaced chair of the House Oversight Committee who refuses to investigate literally anything about the new administration, said poor people ought to stop buying iPhones and start buying healthcare. Chaffetz, whose healthcare comes from the government, has used campaign funds to spend almost $12,000 on Apple products.
Paul Ryan, the architect of this bill and of a series of unrealistic budgets whose primary objective was to enrich the rich, owes pretty much his whole life to government “handouts.” His father’s company made all of its money in government contracts, and Ryan lived on social security for years in his youth.
Even middle-aged baby Tucker Carlson can’t believe what Ryan’s up to:
Senate Democrats have added more than 100 amendments to the bill, all of which have to be debated, in the opening salvo of an effort to keep the AHCA from becoming a law. The first such amendment, which would have changed the name of the AHCA to “The Republican Pay More for Less Care Act” was shot down in what was not record time:
“The amendment, though incredibly well debated, has failed.” We’re at the 12-hour mark of study and have got through one amendment.
— Paul McLeod (@pdmcleod) March 9, 2017
Roger Marshall, an MD and a congressman from Kansas, while commenting on the bill, said:
Just like Jesus said, ‘The poor will always be with us,'” said Marshall, a former obstetrician, in an interview with Stat on Friday. “There is a group of people that just don’t want health care and aren’t going to take care of themselves… Just like homeless people … I think just morally, spiritually, socially, [some people] just don’t want health care…
Just like Trump in his joint session, the congressman seems to have misplaced his bible. The head of North Carolina’s NAACP and ordained reverend William Barber set the record straight on a radio talk show:
Well, that is a form of heresy, again, it’s a misquoting of scripture; it is what the so-called religious evangelicals put out there. […] If you go back to Deuteronomy, that scripture says because the poor will be with you, then you should care for the poor, you should care for the alien, and it was talking to the nation. Jesus, if He did anything, provided free health care.
If you’re just starting to wonder how it is that the Christ-“quoting,” bible-thumping members of the GOP could get their religion so mixed up, the Internet’s way ahead of you. Meet ‘What Would Republican Jesus Do’:
 Several Republican governors turned down this Medicaid expansion, not so much spiting their noses as spiting their poor. Whenever those GOP govs got turned out for Democratic ones who accepted the expansion, the program became as wildly popular as it was everywhere else.