President Donald Trump is coming to Louisville Monday to tout a plan that doesn’t just roll back access to health care for all the people who gained it in recent years, including 500,000-plus Kentuckians.
Trump also is defaulting on a commitment made a half-century ago to care for our most vulnerable: poor people who are elderly, disabled, pregnant or very young. This attack on traditional Medicaid goes far beyond Republican promises to repeal the Affordable Care Act; it is cruel and contrary to what candidate Trump promised when he tweeted “no cuts to Social Security, Medicare & Medicaid.”
Also embraced by Senate Majority Leader Mitch McConnell, the plan contradicts Trump’s pre-inaugural promise of “insurance for everybody.” In an interview with The Washington Post, Trump elaborated, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
But it would happen to older, lower-income and rural people, who have been able to afford care under the Obama-era rules, but would be priced out or kicked off by the plan that Speaker Paul Ryan is pushing through the U.S. House.
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Estimates of how many additional people would be uninsured range from 15 million (Brookings Institution) to 24 million (Congressional Budget Office.) McConnell touted CBO estimates that the American Health Care Act would trim premiums and the deficit, but he forgot to explain that it would do this by driving sick, low-income and older people from the market with higher premiums.
Some conservatives, including Sen. Rand Paul of Kentucky, oppose the Ryan-Trump plan because the government would still spend billions on health-insurance subsidies. Their lust for laissez-faire is fantasy-based. Government must play a critical role if the billions of public and private dollars spent on health care are to yield a common good rather than relegating millions of Americans to sickness, death and bankruptcy because of their economic or health status.
The challenge that Trump only recently realized was “so complicated” is how to balance competing concerns to get the most value and best outcomes for the most people. By that standard, the law enacted after months of debate in 2010 is far better than what Republicans are hoping to rush through now.
The Republican plan would facilitate a massive transfer of wealth from bottom to top — a $600 billion tax cut for the wealthiest and a $900 billion cut to Medicaid which serves the poorest. There’s no evidence that the economy is suffering from the taxes that are paying for more health care. Jobs have grown for a record 76 months, unemployment claims are near a 44-year low and the stock market is setting records.
The plan would hammer Kentuckians by ending expanded access to addiction treatment and the Medicaid expansion that covers the working poor.
New figures reveal that for 83 percent of individuals insured in the ACA marketplace, premiums increased by $1 on average in 2017. Enrollment is down by 4 percent. Hardly the “collapse” that Republicans keep portraying.
Congress will reject most of Trump’s budget cuts which Republican Rep. Hal Rogers of Kentucky aptly described as “draconian, careless and counterproductive.”
They should back away from this bad plan, too, and remember 2008 when both presidential candidates made health care a top priority and a large majority of Americans favored fundamental reform. It makes more sense to build on what’s been gained, rather than try to turn the clock back 50 years.