Whatever. Since we’re headed into a short recess here, when they’re all going home to not hold town hall meetings for a bill with 12 percent support, let’s take a step back and assess. Whatever Republicans try to do to this bill will be for two reasons and two reasons only: one, to get it some more votes; and two, to finagle it a better Congressional Budget Office score. Because there’s a number at which their cruelty sounds not quite as cruel as people expect of them. If “only” 16 million are kicked off insurance in the new version, it will be hailed as moderate.
But we can be sure that none of the changes Senate Republicans are about to make will be for the purpose of ensuring that Americans have better health care. God forbid that. They don’t want that. Giving people better health care isn’t why they’re doing this. If you look back over the history of this country, I don’t think you can find a single prominent instance when conservatives have supported broadening access to health care for American citizens. A lot of Republicans—nearly half in both the Senate and the House—voted to create Medicare and Medicaid back in 1965, but that was when the GOP still had liberals. The conservatives were all against it.
Eight years later, Congress passed a big bill creating Health Maintenance Organizations (HMOs). They have developed a mixed track record over the years, HMOs, but at the time, it was a Ted Kennedy bill that was designed to give consumers greater choice. This passed the Senate 69-25 in May 1973, and the 25, sure enough, were all conservatives—Bob Dole, Strom Thurmond, Jesse Helms, and the like (a few were Southern Democrats, still). Two decades after that we had Hillarycare, which Dole said he would filibuster—a semi-shocking deployment of that tactic at that time—and that effort was killed off.
In more recent years, a few conservative policy intellectuals actually applied some brainpower to the goal of reducing the number of uninsured, but that effort famously became anathema to conservative politicians after Barack Obama embraced their idea of an individual mandate. Modern conservative Republicanism, which we can date roughly to Barry Goldwater, has always been against expanding access to health care. So that’s not why they’re undertaking this.
They’re doing it for two reasons. The first is, obviously, to repeal Obamacare. Because if they fail at that, their base will turn on them. After seven years and all those repeal votes, they have to follow through with something. I’m sure that on some level Mitch McConnell would prefer that this problem go away. But he is just as guilty as any Republican pol of whipping up the base on Obamacare hatred. He’s the one who coined “root and branch” as the descriptor of the way in which they had to get rid of Obamacare. You can’t spent seven years talking like that and then expect to be able to skate away from the consequences of your rhetoric.
The second reason is that they want to smash Medicaid. Now, not all Republicans hate Medicaid. Many Republican governors like it fine. The people in their states, from school children to the elderly, and not just poor, need the services it pays for.
But Washington Republicans despise Medicaid. They want to tear it to pieces. And this bill will: Thursday afternoon, the CBO came up with an updated assessment of the bill’s impact on Medicaid, and it’s brutal. The current draft calls for cuts to Medicaid of around 25 percent over the next decade. CBO has now extrapolated that in the second decade, Medicaid would be cut by 35 percent (compared to current levels). That is exactly what Washington Republicans want, and it’s a big reason they’re trying to pass this bill.
But even then, the real preference of most of them would be to drop the whole business and move on to taxes. Notice I didn’t say tax “reform.” It’s impossible to call what they want to do “reform.” Oh, cutting the corporate rate some is fine, but that’s not really what they’re up to. Wealthy individuals need more of their money back. The Washington Post editorialized earlier this week, surveying public comments by Paul Ryan and Mike Pence, that their words “reinforced suspicions that, for all their talk of reform, slashing taxes, mainly for the wealthy and corporations, is the one policy that Republicans agree on and therefore the only policy they are actually going to enact.”
Tax cuts, of course, have been one of the secret reasons for doing health care “reform” too. Everything but improving people’s health. If they wanted to do that, they could fix what’s wrong with Obamacare easily enough. But why should a health care bill be about that?