GOP cuts are moral challenge for America

Republican plan trades health care for 24 million to provide tax cuts to the super-wealthy

THE BIG NEWS IS, of course, the “score” from the Congressional Budget Office detailing that the House Republican bill to repeal and replace the Affordable Care Act/Obamacare will result in 14 million Americans losing health insurance by 2018 and 24 million by 2026.

Before that, something else caught my eye today from the Bangor Daily News. It’s a blog post from a woman named Crystal Sands who writes about how the ACA enabled her and her young family to take a chance and find a new life as farmers. Her post, “The ACA makes a simpler farming life possible for our family,” says this:

I’m a writer, an online professor, a farmer, a wife, and a mom. None of these jobs offer health insurance for me and my family, so our family purchases our health insurance through the Affordable Care Act. We work hard, but we try to work differently. If you read my blog, you know we’re learning to grow and raise our own food, and our health insurance through the ACA makes this possible.

The ACA has helped me to become a better mom, a better wife, a better teacher because I am not so overworked, and it has made it so I can learn to be a farmer. I’m also just a better person. I’m not sick and overworked. I’m more patient and more kind and more helpful to everyone. And this is my story. There’s so much potential here to make lives better. There are many people, including many farmers, who depend on the ACA. I hope we don’t lose sight of that.

And now, CBO’s Cost Estimate of the American Health Care Act. Bottom line — $894 billion in tax cuts financed by $1.2 trillion in cuts to Medicaid and to subsidies/tax credits for private health insurance. Those cuts will produce an increase in numbers of uninsured Americans of 14 million by 2018, 21 million by 2020, and 24 million by 2026. Of the 24 million, 14 million will lose Medicaid and 10 million will lose private coverage, employer-sponsored and individual.

What are the biggest tax cuts? A total of $275 billion in cuts come from new Medicare payroll taxes on earned ($117 billion) and investment/unearned ($158 billion) income implemented in 2013 on wealthy households (single adults with incomes over $200,000 and families over $250,000).  The Center for Budget & Policy Priorities estimates that the richest 400 US families will get annual tax cuts of $7 million per family, while the 162 million households with incomes under $200,000 will get nothing. Other big cuts: $145 billion in tax hikes for health insurance companies, and $25 billion for tax hikes on the pharmaceutical industry.

What’s this bill about? It’s about cutting taxes for wealthy Americans and powerful industries by cutting health insurance for low and moderate income Americans, including $880 billion less for Medicaid and $673 billion less for subsidies to purchase private insurance between 2017 and 2026. That’s it folks. Pardon the familiar expression: It’s the taxes, stupid!

It’s true that the Republicans’ proposed tax credit/subsidy structure to buy private health insurance is a mixed bag. For example, a single adult with an income of $68,200 (450 percent of the federal poverty level) gets no subsidy under the ACA versus $2,450-$4,900 (in 2026 dollars) under the Republican plan. On the other hand, a 64-year old with an income of $26,500 gets a subsidy of $13,800 under the Affordable Care Act versus a $4,900 subsidy under the Republicans’ American Health Care Act. Big difference for the folks who need help the most.

“Everybody’s got to be covered,” said Donald Trump about his health care agenda. House Speaker Paul Ryan also promised repeatedly that no one would lose coverage. So much for that. Opponents to Trump and Ryan’s plan now include the American Hospital Association, the American Medical Association, AARP, the American Nurses Association, and many more.  On Trump’s side, the medical device industry and parts of the insurance industry.

By the way, the director of the Congressional Budget Office is named Keith Hall. He has held the job since 2015. When the job is open, the new director is chosen by the House and Senate chairs of the respective House and Senate budget committees. In 2015, both committee chairs were Republicans who chose the new director. Even more interesting, in 2015, the House Budget Committee Chair was Rep. Tom Price of Georgia, now Trump’s health and human services secretary, who is criticizing the new CBO numbers as wrong, even as he has no numbers to offer instead. CBO numbers are usually off, but only because the estimating process is inherently difficult and uncertain. CBO staff are some of the best professionals around.

Meet the Author

The CBO report, with its matter-of-fact language and bland tone, makes clear that the Republican legislation is a moral challenge for America. This is a test, not just about our health care system, it’s a test about who we are as a people, and as Americans. This is a fight worth having. I side with Crystal Sands.

John E McDonough is a professor of practice at the Harvard TH Chan School of Public Health.  He blogs at