When you are half-listening to the news, and you hear that something is in the air that is especially dangerous to the young and the elderly, you expect to be told it is some kind of virus or plague. Yesterday, after weeks of secrecy, Senate Majority Leader Mitch McConnell unveiled the Senate "repeal and replace Obamacare" legislation. It is as bad or worse than expected and it is especially harmful to the young and the elderly. It is a plague upon the people of this country and the grossest act of public immorality in years.
"After weeks of working behind closed doors, and despite claims that the Senate would start over and develop its own legislation, there is very little that differs from the House bill," said Daughter of Charity Sr. Carol Keehan, president of the Catholic Health Association. "The small tweaks made in the newly released Senate bill do not change the fact that millions will lose their health care especially through a complete restructuring and deep federal funding reduction to the Medicaid program."
Medicaid is the joint federal-state program that provides health care to the poor. But, it covers 39 percent of all children and 64 percent of the elderly living in nursing homes. Medicare, the health care program for the elderly, only covers a few months of nursing home care after a hospital stay. Long-term care, which is insanely expensive, is paid for by Medicaid. Cutting Medicaid disproportionately harms the young who are poor, and there are a lot of them, and the elderly who are sick. In short, the GOP proposal is a variety of plague.
It gets worse. The cuts to Medicaid proposed by the Senate bill are needed to shore up protection for people with preexisting conditions after such protection was left murky in the House-passed bill. But, like the House bill, the cuts in Medicaid are really the result of something different, something that has nothing to do with the health of the American people: The GOP wants to roll back taxes on the uber-rich.
We can all disagree about what is the best way to keep health insurance premiums down or extend coverage to more people. Certainly, some of the predictions made by those who voted for the Affordable Care Act have proven off-the-mark and the law needed some changes. What we cannot lose sight of is this: Both the House and Senate bills are exercises in Social Darwinism, a way to reward the wealthy and the healthy and to place heavier burdens on the poor. It is morally repugnant.
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It gets yet still worse. Recognizing that states should have some room to experiment, the ACA allowed them to apply for waivers from parts of the law if certain requirements were met. As Danny Vinik explains at Politico this morning, most of the requirements have been eliminated and now a governor and state insurance commissioner can request the waiver without authorization from the state legislature. This will only further the "race to the bottom" that will result from this bill, as more and more companies purchase lousy insurance from states that demand little in the way of basic coverage.
The Los Angeles Times put together a useful comparison of current law with both of the GOP proposals. The Congressional Budget Office will undertake a "scoring" of the bill: You will remember that the CBO projected the House bill would cause some 23 million people to lose their health insurance within ten years. This is unambiguously immoral.
There is another reason the Republicans in Congress are so intent on passing repeal and replace legislation, and that reason can be viewed cynically or not. On the one hand, it is good for democracy when politicians keep their word and do what they promised to do during the campaign. But, there is a deeper cynicism at work here. The Republican Party's animus towards President Barack Obama was unnatural and, so, rather than work with him on the ACA, they stood on the sidelines and complained. McConnell famously admitted his goal was to make Obama a one-term president. The Republicans fanned the flames of the Tea Party movement and of other extremist groups. So, they are keeping their word, but that word was itself inspired by, and implicated in, some very irrational hostility to President Obama.
That hostility was not confined to Republican Party office holders. The U.S. bishops' conference had it in for Obama from the start. Remember their postcard campaign against the imaginary Freedom of Choice Act? Remember the attacks on the University of Notre Dame when it invited the president to speak at their commencement? Remember that they could not bring themselves to support the ACA?
Then there was the Department of Health and Human Services' contraception mandate. The initial rule enacting the mandate was a disaster, with no exemptions for religious organizations, but a few weeks later, the Obama administration pulled back, offering a compromise. The compromise wasn't perfect, but it was a big step towards addressing the bishops' concerns. The USCCB issued a statement the very same day, stating that the compromise "is unacceptable and must be corrected."
Yesterday, around 7 p.m., the USCCB sent around a statement that began, "After the U.S. Senate introduced a 'discussion draft' of its health care bill, Bishop Frank J. Dewane of Venice, Florida, Chairman of the U.S. Bishops’ Committee on Domestic Justice and Human Development, highlighted certain positive elements in the bill, but reiterated the need for Senators to remove unacceptable flaws in the legislation that harm those most in need." The odd thing here is that the press statement starts by affirming the positive elements in the Republican legislation, even though the actual statement from Bishop Dewane starts with a criticism of the proposal. Similarly, statements about immigration from the USCCB have started with the need for border security, which is not where Catholic social doctrine begins its examination of migration issues.
I know it bothers the leadership of the USCCB when I describe the fifth floor, where the executive offices are located, as a "Francis-free zone." Yet, they keep giving me justification for that designation.
What is curious about the politics is that the first four Republican Senators to voice opposition to the proposal all wanted it to be harsher! Sen. Rand Paul of Kentucky even called it "Obamacare Lite." Joining Sen. Paul in withholding their support for the proposal as written are Sen. Ted Cruz, Sen. Ron Johnson, and Sen. Mike Lee. I never thought I would be grateful that any of these four are public officials, but their desire to make the bill yet more draconian may drive off others, although I have to say: If you are even thinking of voting for this bill, you are not properly deemed a moderate.
A couple of months back, I predicted that this dynamic — a pull to the hard right would lose votes from the center, and a pull to the center would lose votes from the far right — would prevent the lower chamber of Congress from passing legislation. I was wrong. The so-called moderates caved and the bill was made more dreadful in order to appease the Freedom Caucus. I shall not venture such a prediction again regarding the Senate. Sen. McConnell may ram this through next Thursday. In the strictest sense of the word, it is a shame.
[Michael Sean Winters covers the nexus of religion and politics for NCR.]