The Republican Party won control of government promising help. Help for the unemployed, help for the uninsured; help for the struggling, help for the anxious. But help isn't on its agenda. The plan, instead, is cruelty.
It’s how we get the American Health Care Act, a profoundly nasty bill whose callousness is just barely matched by its shoddy, haphazard construction.* Here is what the AHCA, deemed “Trumpcare,” would do if signed into law: Allow states to waive coverage for “essential health benefits” like hospitalization, maternity care, and mental health coverage; allow discrimination against people with pre-existing conditions like asthma, cancer, and other ailments without a safety net for Americans priced out of the individual market; allow employers to hollow out health benefits for their employees, threatening health insurance for the millions of Americans who receive it through their jobs; remove funding that helps give care to children in special education classes; and not least, it would cut Medicaid spending and end the Medicaid expansion, taking $880 billion from the program.
Under the original AHCA, 24 million people would lose insurance by the end of the decade, relative to the status quo. We don’t have an outlook for this latest, and final, version from the House; desperate to pass the bill and avoid further scrutiny, House Republicans have ignored the Congressional Budget Office and kept the text of the bill from public view. But when you’ve ended protections for pre-existing conditions and destabilized individual and group markets, it’s a virtual guarantee that even more Americans will lose health insurance on top of those 24 million.
That’s millions of low-income Americans, unable to pay for basic—but often life-saving—care. That’s millions of American women, ineligible for health insurance because they were once pregnant, or abused, or raped. That’s addicts, many in communities that voted for Donald Trump and back Republican lawmakers, who can’t purchase or afford insurance because of their addiction. That’s someone struggling with mental health issues, now deemed a high risk for insurers. That’s countless Americans who, through chance or fate, live with injuries and disorders and diseases that will leave them uninsurable without the protections of the Affordable Care Act.
All of this is being done not to improve the American health care system or deliver better (or cheaper) care—as House Speaker Paul Ryan continuously and falsely insists—but to cut taxes on the richest taxpayers. The AHCA, in other words, isn’t a health care bill as much as it is a vehicle for upward redistribution, taking from the bottom to give to the very top.
On Thursday, House Republicans passed this bill, 217 to 214, marking their triumph with applause and celebration. In their minds, they’re fulfilling their promise to “repeal and replace” the Affordable Care Act, delivering on nearly a decade of rhetoric. It’s unclear if the Senate will even consider this specific proposal, much less vote on it. Majority Leader Mitch McConnell has already said that his chamber will wait on a score from the Congressional Budget Office, an early sign, perhaps, that Senate Republicans have little interest in assisting their House counterparts. (Some Senate Republicans have also already indicated that they will be working on their own bill, but who knows how much of the House version will ultimately be incorporated.) In the meantime, President Trump celebrated the House vote with a ceremony in the Rose Garden, praising a bill that trashes every promise he made during his campaign, that harms millions for the sake of a wealthy few. “This is a great plan, I actually think it will get even better,” Trump said, before stating outright what passage of the bill was actually about—fulfilling a campaign promise. “Make no mistake, this is a repeal and replace of Obamacare.” Whatever comes next, we can still now pass judgement on House Republicans. From its crafting and introduction to its passage, what we’ve witnessed from Ryan and his caucus is an incredible contempt for process, truth, and their own constituents. Like the Affordable Care Act before it, the American Health Care Act reorganizes one-sixth of our economy. But unlike the ACA, which was signed after a year of public hearings and fierce debates, the AHCA was slapped together in secret with little regard for the consequences or knowledge of its effects. When pressed on its contents, lawmakers shrugged, content to vote in ignorance for a bill whose defining feature is, again, its profound cruelty. And when asked about this—when asked about the distance between their rhetoric and what we know about the proposal—Republicans simply lied. “We’re not taking a benefit away,” said Majority Leader Kevin McCarthy to CNN on Thursday. “Nobody on Medicaid is going to be taken away.” This isn’t true. Little which Republican advocates have said about the bill has been true.
Indeed, if there’s a single worst actor in this drama, it is Ryan, whose reputation for personal integrity and political competence have little basis in reality. Throughout, Ryan has misled and obfuscated, spinning the AHCA as a net benefit for Americans, when it’s anything but. And he’s done this in service of his central agenda: tax cuts and the evisceration of a safety net he once blasted as a “hammock” that lulls Americans to “dependence.” Most Americans oppose this rhetoric, which is why Ryan and his party have to lie to sell their program of slashing insurance for the poor to fund tax cuts for the rich.
Ryan and his singular drive are emblematic of the party he leads. The GOP is well in the grip of an ideological mania, committed to a rigid and hierarchical vision of America, where help comes only to those who deserve it, and where the “deserving” are a small, select group, chosen by the market, or defined by their inherited wealth and privilege. If the American Health Care Act is a callous and destructive bill, it’s because it come from a party that’s made cruelty its cardinal virtue.
*Correction, May 5, 2017: This article originally misstated that House Republicans passed the Affordable Health Care Act. It is the American Health Care Act. (Return.)