Columns » Ernest Dumas



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Republicans at long last may be about to see their most fervent wishes and wildest predictions materialize — millions of people losing their medical and hospital coverage, unaffordable insurance, lost jobs, a Medicare financial crisis, mushrooming federal budget deficits and fiscal crises across state governments.

But all of that was supposed to be the result of passing Obamacare, which actually produced diametrically opposite results. Now it is about to happen as President Trump and Congress try to crash the 4-year-old program and "replace" it with something they promised would be much better. They must convince a major share of American voters that more than 20 million people losing health insurance, poorer coverage for millions more and the economic dislocation that all of it will cause are products of Democrats passing the Affordable Care Act in 2010 and not of their own efforts to scuttle it with something that will come to be known as Trumpcare the day that he signs it, if that, indeed, happens.

It has to be the most dubious U.S. political experiment in modern times, maybe since Herbert Hoover. If they can pull it off, it will be a bigger propaganda coup than the Obamascare campaign inspired by Republican consultant Frank Luntz in 2010 and maybe the best since Goebbels. Right now, it doesn't look so promising.

The House of Representatives narrowly passed a bill it called the American Health Care Act that the rosiest predictions say will drive more than 23 million off insurance, make it more unaffordable for many others, close hospitals and slash jobs while giving huge tax cuts to the richest Americans. President Trump celebrated with Rose Garden toasts and called it one of the greatest triumphs in history. Polls showed that Americans mostly hated it, and now Trump does, too. He's counting on Mitch McConnell and 13 other male senators working in secret to write something that they hammer 50 Republican senators into approving in the next two weeks.

Remember that in 2010 the party said Obamacare had been passed in haste, after a year of public hearings and numerous drafts in both houses and after adopting a number of provisions suggested by Republican senators — and all of that after a yearlong presidential campaign in which all the candidates had outlined their plans for universal health insurance, most of them along the lines of the Republican health care plan of the 1990s (basically Obamacare).

No one really knows what McConnell and the 13 amigos are up to, but if leaks are reliable, they will adopt roughly the key changes in Obamacare made by the House — repeal taxes on the rich and some industries that deal with health, while eliminating many of the patient safeguards in the present law and scuttling much of the historic Medicaid program — but spread the disaster out over a longer period, until after at least two more congressional elections and the worst well into the next decade.

See, the strategy may not be obvious to many voters and, anyway, Frank Luntz can produce timely catchphrases that will turn the bad politics around with ample money from Koch Industries and the beneficiaries of the tax favors. They can make it look like Obamacare and Democrats are to blame.

The strategy may be savage, but it is not bereft of logic. They now control all three branches of government. Obamacare was crippled almost from the outset. While one of the Supreme Court's five members foiled the party by holding that the federal government could regulate social and health benefits, as it had been doing since the 1930s with judicial blessings, all five said it couldn't offer health benefits to all poor Americans unless each state went along. Thirty-one states, including Arkansas, and the District of Columbia went along with Medicaid for poor grown-ups, but the other 19 states, all controlled by the GOP, left Obamacare about 10 million short of the forecast that 30 million would gain insurance.

A number of states threw monkey wrenches into the machinery. The Arkansas legislature forbade the state from using a dime of the $10 million sent by the federal government to help people navigate the complex digital system of signing up for subsidized insurance on the private market or Medicaid. Still, some 400,000 people became insured. Arkansas hospitals flourished while many in surrounding states continued to close.

Republicans in the U.S. House saw another opening to drive up insurance costs, chase people off the program and force insurance companies to pull out of the market. They filed a lawsuit saying the federal government shouldn't be paying out-of-pocket costs for patients. The Supreme Court, with a solid Republican majority once again, will agree. Anticipating that result, insurance companies began pulling out for 2018. The others anticipate big customer withdrawals when they are confronted with the higher costs.

Meantime, Trump's orders to his eager Health and Human Services secretary to cripple Obamacare administratively to hasten his predicted collapse is having the desired effect.

In Arkansas, while expressing mild alarm, the governor is speeding the process by asking Trump to waive the law so that he can award medical care for the very poor not on the basis of need, but on whether they are morally deserving by holding down a steady job, or whether they can scrounge up the money to pay more than their poverty-level wage allows when they are driven from Medicaid totally into the private market. Trump surely will oblige him, which will restore 60,000 or more Arkansans to the ranks of the uninsured. Whom to blame? Are you betting on the intelligence of voters or on Frank Luntz?


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