A Heartbreaking Work of Staggering Misogyny and Depravity

The Graham-Cassidy bill does not improve on its two #Trumpcare #GOPcare #deathcare predecessors. To the contrary, it is apparently even more draconian, more viciously anti-female and anti-poor, and it has the added kicker of making even private insurance coverage of abortions functionally illegal, denying women maternity coverage and preventative care, and permitting states to allow insurance companies to jack up premiums for essential benefits and pre-existing conditions — thereby pricing tens of millions of people out of insurance entirely. (Analyses of the ways in which this bill is particularly disastrous for women and takes laser-like aim at reproductive and maternity health are here, here, here, and here; analyses of its equally savage attacks on the poor, the sick, and the elderly are here and here.) 15-18 million could lose coverage in two years, and another 32 million after 2026; further, premiums will go up across the private insurance market — no one will escape these negative consequences. (Except, of course, Congress; Republicans make sure Congress is exempt from the dire effects the GOP inflicts on the rest of us.)

Further, the bill cuts $215 billion in Medicaid funding. At the same time, its block grant formula targets blue states, taking money from their taxpayers currently used to support Medicaid expansion, and transferring it to red states that refused to expand Medicaid under Obamacare, without guidelines, i.e., to do whatever they want with it — a massive redistribution of wealth from money-generating states to poorer ones, with no apparent requirement that the block grants even be used for healthcare. In other words, it steals from the richer blue states who have money earmarked for healthcare for the poor and gives those stolen funds to the rich in red states. The bill also requires each state to develop its own health care system from scratch within two years — something that all 50 Medicaid directors have warned is impossible even without massive funding cuts, and that will upend the provision of healthcare across the country.

The bill is an abomination.

I don’t pretend to be any kind of healthcare policy expert, but like most citizens who are following this latest assault on the general welfare by the political party that currently controls our government and occupies the White House, I either have more understanding of what’s in this bill than the GOP Congresspeople who supported it out of the gate, who are unable to articulate any policy rationale for it, or these senators and House members are cruel to the point of sadism, and vicious hypocrites and liars on top of it. (Although, as it happens, these propositions are not mutually exclusive, and both appear to be true.)

This article from Vox is an extraordinary indictment of the GOP senators supporting the bill using their own words, as it lays bare their complete indifference to the lives of their constituents and the naked cynicism of their support:

GOP senators are rushing to pass Graham-Cassidy. We asked 9 to explain what it does.

It really needs to be read to be “believed” but in summary:

• they admit that they don’t care about the effects of repealing the ACA as long as it is repealed;
• what they are motivated by is obtaining a political “win”;
• they will support anything that constitutes a repeal without regard for the actual, real-life consequences on living human beings;
• not one of them appears remotely interested in the loss of coverage, the increase in premiums, the denial of access to care, and the resultant deaths, bankruptcies, and upending of the healthcare markets that are being widely predicted;
• they spout vacuities about “states” can “innovate” and be “more efficient” but have no idea how;
• not one could articulate a broad policy rationale for the bill; instead, they offered platitudes that Obamacare is bad, but when asked the basis for their belief that the states could or would provide more coverage, in light of the massive cuts to federal funding for health insurance, they responded either with lies that the cuts are not cuts, or attacked the CBO , or simply repeated their blind faith in states’ supposed efficiency.

Sen. Chuck Grassley also admitted what is obvious to all in an interview, when he said,

“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Iowa Sen. Chuck Grassley told local reporters, according to The Des Moines Register. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill."

In short, what we have is a party that demonized the Affordable Care Act from its inception purely for political show in the hopes of kneecapping President Obama and the Democratic Party; lied to its base for eight years about the content and effects of the bill, also purely for partisan and deeply cynical political purposes; campaigned on repeal without any plan for what would be better, because the ACA is modeled on the Republican Mitt Romney’s healthcare legislation; and whose sole basis for repeal now is the eight years of lies it told its base that Obamacare equates to modern-day slavery. The Republican Party is in a political box of its own making.

But none of this is necessary. Polls indicate Obamacare is popular (because it works) and that the public opposes cuts to Medicaid. This rush to ram a hateful piece of legislation down the constricting throats of the populace so the GOP can crow about a legislative “win”, consequences be damned, is criminally irresponsible. Indeed, it is a depraved act of barbarism. For what the GOP is saying is that in order avoid the potential political consequences with its base of its years of cynical attack on Obamacare, and in order to finance the $1.5 trillion tax cut for the extremely wealthy and corporations that it’s salivating for, the GOP will refuse to fix and improve a law that is working, and instead, will force through a law that will kill and/or bankrupt its own constituents.

Because make no mistake, that will be the result, as the links above in the first paragraph demonstrate. This agonizing tweetstorm from Victoria Brownsworth captures the moral depravity of the GOP’s bill in all-too-common human terms:

Never mind that the polls indicate that Americans’ support for the Affordable Care Act has steadily increased despite Republicans’ repeated lies about it and efforts to sabotage it, because where it was implemented in good faith, it largely works; never mind that because the ACA, by design, reduced the number of uninsured by millions, any repeal will in turn increase the number of uninsured by millions. Never mind that the ACA included numerous extremely popular provisions, including ending lifetime caps on coverage (Jimmy Kimmel’s monologue explaining that these caps would have resulted in the death of his baby is a profound illustration of why this is necessary), preventing insurance companies from denying coverage or jacking up premiums on those with pre-existing conditions, and requiring insurance companies to provide essential benefits such as maternity care, pediatric visits, and preventive care. Never mind that this bill will cause chaos in the economy and health care markets. Never mind that because it is cruel, misogynist, and disastrous, it is opposed by doctors, hospitals, insurers, and patients’ rights groups (basically the entire health care sector; see also here and here), all Democratic governors, a number of Republican governors (indeed, only 15 of 31 GOP governors were willing to announce their support for it), all 50 Medicaid directors, women’s rights and women’s health groups, and of course everyone in Congress who is not a Republican.

The corruption, duplicity, and hypocrisy that have given rise to this bill and its justifications are also staggering. To set forth a few:

• After 8 years and 8 months of failing to produce a viable alternative to the ACA, the GOP is now offering instead to punt the job to the 50 states. The tautological argument they offer is that “Washington” cannot come up with a good plan and but the supposedly nimbler states can individually do so with far less money and in far less time than “bureaucrats” in D.C. The reality, however, is that “Washington” did come up with a good plan, the Romney-inspired ACA, which just needs some legislative fixing. The GOP leadership does not want to admit that, and because it is incapable of developing an alternative, it is using its own failures as a pretext for dismantling a working and popular program.
• The central premise of bill itself is based on nothing but magical thinking: give the states billions less money than the federal government had to work with, take money from the states that have insured their citizens and cut their funding, and presto, the problem of healthcare will be solved! How? States are innovative! Never mind that before the ACA, the states had not solved the problem of healthcare coverage, giving rise to the widespread discontent and suffering (lack of coverage, lack of preventative care, personal bankruptcies) that helped propel Barack Obama to victory in 2008. Somehow the decades of failures at the state level to insure their citizens, necessitating a federal fix in the form of the ACA (and Medicaid and CHIP before that), are going to magically disappear because “states are more efficient”? The GOP is vomiting out ideological fantasy in lieu of policy. (Just as with the Iraq invasion — the last time a Republican president and Congress so brazenly substituted partisan fantasy for data — the result will be a totally avoidable loss of life and escalation of human suffering.)
• Even the GOP’s supposed trust in the states to do better than the ACA is itself another form of lying hypocrisy. Graham-Cassidy does not give states free reign to develop programs; it will not permit even private insurers to cover abortion and possibly not birth control either. Notably, one of the bill’s supporters, the inaptly named John Kennedy, has submitted amendments to preclude the states from using any block grant funds on a single payer system and to force Medicaid recipients to work in exchange for healthcare (not clear how sick people are supposed to do this..?). In other words, the vaunted “innovation” of the states is to be cabined by Republican orthodoxy, preventing states from implementing progressive legislation to help their citizens or to cover services their citizens want and have a constitutional right to engage in, like abortion. The GOP’s talismanic references to “the states” is yet more of the same tired, hypocritical bullshit: even as they recite the mantra that states are better suited to develop their own healthcare systems, the GOP seeks to straightjacket liberal states from implementing progressive legislation because it conflicts with their own ideology.
• At stake for the GOP is the $300-$400 million the Koch Brothers and their political network have pledged to support Republican candidates in 2018. Putting aside the fact that it is an obscenity that this kind of money can be used to buy politicians, the Koch Brothers have made it clear that ACA repeal and tax cuts are the motivating drivers of their support, and that donors will “go home” if the ACA is not repealed and corporate tax cuts are not enacted. Donations are drying up, so what’s a little loss of human life to reel them back in?
• The bill has no score from the non-partisan Congressional Budget Office (CBO), and there will be no time for a full analysis before the vote on the bill. McConnell is scheduling the vote for next week in order to take advantage of the reconciliation rules (which expire 9/30/17), which avoid the filibuster and thus the need for bipartisan support. Until 9/30, this bill can pass in the Senate with 51 votes (all but two Republicans supporting and Pence casting the tie-breaking vote), provided it satisfies the Byrd Rule, but after September 30th reconciliation cannot be used for this legislation. McConnell knows that this hyper-partisan bill is deeply destructive and will get no Democratic votes; he also knows that the more the public knows about the bill, the less support it will have, so, as he did with its predecessors, he plans to take a vote without Congressional debate or hearings or testimony from stakeholders —in other words, without the process of “regular order” that John McCain keeps bemoaning and by which responsible politicians consider whether to adopt new legislation and what to include in it, particularly when one-sixth of the economy and tens of millions of lives are at stake. (By contrast, while the ACA passed with every Republican dissenting, that occurred only after ten months of debate, hearings, and the adoption of multiple Republican amendments that the Democrats disliked but included in the legislation to in order to effectuate bipartisan compromise with the GOP. The GOP got the Democrats to water down their own legislation in order to secure Republican support, but then voted in lockstep against it simply to try to make Obama fail. National Republicans’ willingness to trade American lives and well-being for short-term political gain is thus nothing new, but their claims that the process of ACA repeal is on a par with the ACA’s enactment are flat-out lies. And, of course, responsible Republican governors accepted the Medicaid expansion of the ACA in order to protect their citizens — thereby giving the lie to the GOP’s false claims about the legislation itself.)
• Faced with the ugly consequences of every version of ACA repeal their party has pushed, the GOP resorted to attacking the non-partisan CBO, whose task it is to evaluate those consequences to enable Congress to evaluate proposed legislation, for telling the truth about the proposed legislation. These attacks have been so unprecedented, cynical, and disingenuous that eight former directors of the agency (from both parties) penned a letter defending it from GOP attacks. Ted Cruz and others are now preemptively demonizing the CBO in advance of its score on Graham-Cassidy because they know the bill will harm millions of people, and they want to be able to continue to lie that it does not. This rejection of uncomfortable facts is no way for any legislator to enact policy, and is a criminally dangerous and irresponsible way to proceed. (The GOP in general, and the Trump administration in particular, has taken to denying facts that refute their ideology — from refugees to crime to the climate and beyond. And in every case, the consequence of their ideological denialism and deceit is human suffering and even death.)
• Graham-Cassidy was introduced even as senators were working on a bipartisan fix for some of the ACA’s weaknesses. McConnell, Graham, and Trump sabotaged this bipartisan process, in order to attempt to secure a “win” by arguing a false Hobson’s choice between “federalism” or “socialism.” (Bernie Sanders’ introduction of single payer legislation in the middle of this fight plays disastrously into GOP hands.) Trump, of course, has been actively undermining the ACA in numerous ways including threatening to end subsidies to the exchanges, in order to manufacture the failure of the legislation — never mind who suffers or dies.)

The fact that this bill is even being considered, that it is being rammed through in this way, that it has no CBO score, that is being conducted outside the normal legislative process without hearings, without learning of the true extent of its effects and without any plan for implementation, without, in fact, democratic process that that allows for a full airing of the issues; the fact that it is so divorced from the reality of human life and suffering, that it specifically targets women’s health and seeks to abrogate their constitutional rights, that private citizens and insurers who agree on full reproductive care will find their insurance policies illegal — all of these facts yield the inescapable conclusion that human lives do not matter to the overwhelming majority of elected Republicans at the national level.

It does not matter to these senators how many weeping parents meet with their legislative aides, describing in detail the ways in which repeal of the Affordable Care Act will wreak havoc on their lives: their inability to pay for the necessary medicine for their children, or their own aging parents, or themselves; the high probability that repeal will result in their children’s suffering and deaths and their own bankruptcies; the ways in which ACA quite literally improved or even saved their lives. It does not appear to matter to them that millions of Americans will lose access to health care and will suffer and many will die for lack of it. It does not matter to them that Americans will go bankrupt trying to pay for healthcare, as they did before the ACA. The decrease in donations is what drives them and they are willing to trade human life for money. There is little difference between them them and assassins for hire.

This is a political party whose moral rot is so metastasized that it has subsumed any basic humanity. Most of them are deaf and blind to the needs of their voters; they are indifferent to democratic process; they are cruel to the point of depravity; they will lie, attack others, and say anything to justify their actions. Our democracy is being stretched to its breaking point and it is exhausting to have to fight against these endless assaults on human life and decency. But we have no other choice. Please raise your voices in opposition to this dreadful bill. Contact your senators and ask your relatives and friends and neighbors to do the same.