The really important thing, however, is not just to realize that Republicans are breaking their promises, but to realize that they are doing so with intent. This isn’t one of those cases where people try to do what they said they would, but fall short in the execution. This is an act of deliberate betrayal: Everything about Trumpcare is specifically designed to do exactly the opposite of what Trump, Paul Ryan and other Republicans said it would.
.. people with incomes over $1 million would save an average of more than $50,000 a year.
And there is a powerful faction within the G.O.P. for whom cutting taxes on the rich is more or less the only thing that matters.
And on a more subjective note, don’t you get the impression that Donald Trump gets some positive pleasure out of taking people who make the mistake of trusting him for a ride?
As for why they think they can get away with it: Well, isn’t recent history on their side? The general shape of what the G.O.P. would do to health care, for the white working class in particular, has long been obvious, yet many people who were sure to lose, bigly, voted Trump anyway.
Why shouldn’t Republicans believe they can convince those same voters that the terrible things that will happen if Trumpcare becomes law are somehow liberals’ fault?
And for that matter, how confident are you that mainstream media will resist the temptation of both-sides-ism, the urge to produce “balanced” reporting that blurs the awful reality of what Trumpcare will do if enacted?
House Republicans Go Off the Cliff
The Republicans were given a gift by Trump’s campaign, a grace they did not merit: the gift of freedom from the trap of dogma, from the pre-existing condition of zombie Reaganism, from an agenda out of touch with the concerns of their actual constituents.
.. Were Trump actually governing along the populist lines he promised, the intra-Democratic debate over
- “identity politics versus
- class politics versus
- making it all about Trump (and Russia?)”
would be fraught and complicated, the best course of action murky.
.. the central Democratic argument in 2018 and 2020 should be entirely clear: Trump is not a populist but just another pro-plutocracy Republican, and everything his party promised you on health care was a sham.
The House Health Care Disaster Is Really About Taxes
It’s unclear what health policy problem this bill would solve. Even for an opponent of Obamacare, it is difficult to understand why House Republicans chose this path to revamping the nation’s health care system.
.. It’s difficult to understand, that is, if you think they were passing a health care bill. It makes more sense when you realize that isn’t what they were doing at all. They were passing a tax cut — one intended to pave the way for more tax cuts.
The flaws of the bill, then, can be understood as a symptom of the flaws of the Republican Party, which has for decades maintained a myopic focus on tax cuts at the expense of nearly all else. Too often, it is a party of people who seem to confuse governing with cutting taxes.
.. Republicans have consistently had difficulty making the case for the bill on health policy merits. It’s not even clear that most House Republican lawmakers know what’s in the legislation.
.. The trick, then, is to make the health care bill’s tax cuts part of that baseline by passing them into law before a tax-reform package. This would provide Republicans with far more room to permanently cut taxes later in the year. In short, Republicans would be able to devise a tax bill that collects about $1 trillion less in revenue but that would still qualify as revenue-neutral under Senate procedure.
This is why Republicans put health care reform at the top of their agenda. Without the bill to reset the federal government’s baseline tax revenue, Republicans would be much more constrained when it came time to overhaul the tax code.
.. But the focus on tax cuts explains why they were so eager to move on an unpopular bill that they had not read and struggled to defend or even describe. And it explains why the bill is so poorly conceived as health policy.
.. Republican presidential contenders said they wouldn’t trade $1 in taxes for $10 in spending cuts? The principle applies in 2017: Tax cuts are the one thing every Republican agrees on.
Soak the Poor, Feed the Rich
Trumpcare will eliminate virtually all of the taxes that Obamacare introduced to expand health care coverage, including the Medicare surcharges that only apply to high earners: 0.9% on earned income and 3.9% on investment income. That in itself is a 16% cut in taxes on investments for a class of people who make lots of money from investments. Health savings accounts will increase the tax breaks available to high-income families. The “Cadillac tax,” which would have affected people with generous health plans, will be pushed back until 2025 (in a transparent bid to improve the bill’s scoring for reconciliation purposes), with the expectation that it will be repealed at some point in the future.
.. Because Trumpcare eliminates the individual mandate, more healthy people are likely to opt out of coverage. This will increase the average actuarial cost of people buying individual plans, which will push up premiums—a transfer from sick people to healthy people.
.. Trumpcare achieves the long-held conservative dream of converting Medicaid into a block grant program, which means that Republican state governments will be able to use the money in ways that are only tangentially related to providing health care for poor people. (Temporary Assistance for Needy Families block grant money, for example, is routinely used to support abstinence programs or premarital counseling services aimed at getting couples to marry.)
.. People will need the same amount of health care no matter what Congress does. If the government pays less for health care, poor people will have to pay more. If they can afford it, Trumpcare is effectively the same as a tax on the poor. If they can’t afford it, it’s even worse. This is as naked an example of class warfare as you’ll see today.