The Editorial Board – The New York Times.
Any doubts about the senseless cruelty underlying the health care agenda put forward by President Trump and Congress were put to rest last week by two government documents. The fantasy that Mr. Trump intends to fight for the health of long-suffering working people should be similarly interred.
One document was the administration’s budget. The other was the Congressional Budget Office’s detailed analysis of the Trumpcare bill passed by the House earlier this month. The budget proposes billions of dollars in cuts to programs that fund research into new cures, protect the country from infectious diseases and provide care to the poor, the elderly and people with disabilities. The analysis said that Trumpcare — formally the American Health Care Act — would rob 23 million people of health insurance while leaving millions of others with policies that offer little protection from major medical conditions. All of this would be done in service of huge tax cuts for the richest Americans.
Consider the fate of Medicaid, a program that provides health insurance to more than 74 million people, among them 60 percent of nursing home residents and millions of people with disabilities. Trumpcare would slash Medicaid spending by $834 billion over 10 years, according to the C.B.O. The president’s budget would take a further $610 billion from the program under the pretext of reforming it. Taken together, this amounts to an estimated 45 percent reduction by 2026 compared with current law, the Center on Budget and Policy Priorities says.
Trumpcare, the C.B.O. says, would make it impossible for millions of people with pre-existing conditions like heart disease or diabetes to buy health insurance. That’s because the law would let states waive many of the requirements in the Affordable Care Act, the 2010 law known as Obamacare. It would also greatly increase the cost of insurance policies for older and poorer people, no matter where they live. By way of illustration, a 64-year-old earning $26,500 a year and living in a state not seeking waivers would have to pay $16,100 a year for coverage, nearly 10 times as much as she would under Obamacare.
The House speaker, Paul Ryan, would argue that Trumpcare is an improvement over the A.C.A. because it would lower premiums for many people, especially the young and healthy. The C.B.O. says he’s right, noting that plans would include fewer benefits. In effect, Mr. Ryan and his colleagues are patting themselves on the back for lowering health insurance premiums by taking away people’s access to medical services.
Apart from inflicting hardship, what would Trumpcare and the president’s budget achieve? Mainly a windfall for wealthy families. The administration has not provided enough information to make good estimates, so it’s hard to say how much the rich would gain from the budget, although it would be a lot. We know more about Trumpcare. The Tax Policy Center estimates that almost all of the tax cuts in that legislation would flow to the rich: The top 1 percent would take home an average of $37,200 a year, while people with middle-class incomes would get a measly $300.
The White House and Republicans in the House of Representatives agree on Trumpcare and are aligned on many parts of the president’s budget. The Senate, however, is still up for grabs. A handful of more moderate senators like Susan Collins of Maine, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia, Lamar Alexander of Tennessee and Rob Portman of Ohio are all that stand in the way of this retrograde assault on American health care.