A couple of days ago, I published a blog post that, among other things, accused Republicans who voted for TrumpCare, a/k/a the “American Health Care Act,” of being murderers. That analysis was based on the Congressional Budget Office’s (“CBO’s”) score, which predicted that 24 million Americans would lose their health care coverage by 2026 under that bill. And even the CBO’s projected future reduction in insurance premiums, we now learn, will result from policies for older Americans becoming so expensive, with so little in the way of subsidies, that many of them will become uninsured. The remaining policies will cover a disproportionate number of younger people, at lower cost but with an enhanced level of human misery.
On further reflection, the word “murder” was probably too harsh. Not because the bill actually would increase the level of health insurance coverage. No, the CBO undoubtedly has it right that a bill that, if enacted, would reduce the subsidies now available for lower-income persons in the individual health-care market and that would slash funding for Medicaid will, inevitably, reduce the level of coverage. The only question is how many people would no lose access to health care, outside of emergency room visits that hospitals are required to subsidize.
The problem is with intentionality. I have little doubt that many Republicans sincerely believe that their plan will lower insurance premiums, reduce the amount of co-pays and deductibles, and provide more flexible health-care coverage. As I pointed out in my earlier post, a person does not have to intend to kill another person in order to get convicted of first-degree murder in Colorado. Creating a risk of death, without caring whether anyone in the zone of danger lives, is sufficient.
James Holmes didn’t know the names of his victims when he opened fire in a crowded movie theater in Aurora, Colorado. But he knew he was creating a risk of death, he didn’t care whether anyone in his line of fire survived, and twelve people died. That was more than enough to convict him of murder.
Now, many Republicans believe that their plan will do better than the CBO projected. And they are counting on regulatory changes, which have neither been announced nor implemented, and future legislative changes, also neither announced nor implemented, to mitigate the impacts that the CBO projected. But that is wishful thinking. It is not reality.
So I will give the benefit of the doubt to those Republicans who want to replace the Affordable Care Act with another program. Let us agree, for now, that the persons who support the “American Health Care Act” are sincere and do not want to cause harm to any other human being. Let us agree that the Republicans who want to repeal and replace Obamacare are not murderers.
Does that change my advice to Republicans? No, not at all. And here’s why.
Even if you convince a majority of the American people that your current bill will not harm anyone, even if you get it enacted by Congress and signed into law, that will not solve your problems. You will face one other problem, more serious than anything else.
Reality.
You’ve been warned that your bill will cause tens of millions of Americans to lose health-care coverage. You are gambling your political futures and the lives of your constituents on your belief that your plan will cause no harm. If you are wrong, the voters will know exactly whom they should blame. And that will be you. The political bloodbath will be personal and devastating.
You will not be able to escape reality. Organizations that study the levels of health-insurance coverage will keep track of how many people will be losing their coverage. You will not be able to credibly attack those nonpartisan groups as being partisan. More seriously, people will vote based on their own experiences and the experiences of their family members, friends and neighbors.
So my unsolicited advice is to tank your current plan and start from scratch. Hold hearings on the problems of the Affordable Care Act. Work with Democrats to improve that program. Do not junk it. Make your constituents physically, mentally and financially healthier. Embrace, don’t reject, reality.
And if you don’t, please do not be surprised when you’re swept from office. You’ve been warned. Are you smart enough to listen?