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Republicans Don’t Feel Your Pain Republicans Don’t Feel Your Pain
(about 4 hours later)
Well before the House voted last week to replace Obamacare with President Trump’s American Health Care Act, Senator Joe Manchin, a centrist Democrat from West Virginia who is up for re-election in 2018, met with the president. By his own account, Manchin told Trump:Well before the House voted last week to replace Obamacare with President Trump’s American Health Care Act, Senator Joe Manchin, a centrist Democrat from West Virginia who is up for re-election in 2018, met with the president. By his own account, Manchin told Trump:
During the campaign, Trump appeared to fully grasp Manchin’s point.During the campaign, Trump appeared to fully grasp Manchin’s point.
Trump declared that “there will be no cuts to Social Security, Medicare & Medicaid” and added that “the middle class has to be protected.”Trump declared that “there will be no cuts to Social Security, Medicare & Medicaid” and added that “the middle class has to be protected.”
Safety net commitments were crucial to Trump’s appeal to white working-class voters, the constituency that put him over the top in the key states of Wisconsin, Michigan, Ohio and Pennsylvania. In Manchin’s West Virginia, Trump swept every county, carrying the state with 67.9 percent of the vote compared with Hillary Clinton’s 26.2.Safety net commitments were crucial to Trump’s appeal to white working-class voters, the constituency that put him over the top in the key states of Wisconsin, Michigan, Ohio and Pennsylvania. In Manchin’s West Virginia, Trump swept every county, carrying the state with 67.9 percent of the vote compared with Hillary Clinton’s 26.2.
Even after he won the presidency, Trump maintained his pro forma commitment to social insurance.Even after he won the presidency, Trump maintained his pro forma commitment to social insurance.
What in fact would the Trump-backed measure passed by the House last week actually do?What in fact would the Trump-backed measure passed by the House last week actually do?
The bill cuts spending by Medicaid by more than $800 billion over ten years. This enormous cut endangers continued coverage for millions of struggling voters who cast ballots for Trump. The bill also includes starkly regressive tax provisions.The bill cuts spending by Medicaid by more than $800 billion over ten years. This enormous cut endangers continued coverage for millions of struggling voters who cast ballots for Trump. The bill also includes starkly regressive tax provisions.
By 2022, when the provisions of the AHCA would be fully effective, those in the bottom two quintiles would pay higher taxes, up to $160 annually, according to the nonpartisan Tax Policy Center. Those in the middle of the income distribution would get an average annual tax cut of $240; those in the fourth quintile, a cut of $510; and those in the top 20 percent, an average tax cut of $2,830.By 2022, when the provisions of the AHCA would be fully effective, those in the bottom two quintiles would pay higher taxes, up to $160 annually, according to the nonpartisan Tax Policy Center. Those in the middle of the income distribution would get an average annual tax cut of $240; those in the fourth quintile, a cut of $510; and those in the top 20 percent, an average tax cut of $2,830.
The distributional impact of the tax provisions is most apparent in the highest income brackets: those in the top one percent, whose household income is more than $770,000, would get an average tax cut of $37,220. Those in the top 0.1 percent, who make $4 million or more, would get an average reduction of $207,240.The distributional impact of the tax provisions is most apparent in the highest income brackets: those in the top one percent, whose household income is more than $770,000, would get an average tax cut of $37,220. Those in the top 0.1 percent, who make $4 million or more, would get an average reduction of $207,240.
According to the nonpartisan Center on Budget and Policy Priorities, at the highest point of all, the 400 households with annual incomes exceeding $300 million apiece, the tax cut would be worth an estimated $7 million.According to the nonpartisan Center on Budget and Policy Priorities, at the highest point of all, the 400 households with annual incomes exceeding $300 million apiece, the tax cut would be worth an estimated $7 million.
The tax cuts are financed, in turn, by the multibillion dollar reduction in Medicaid spending noted above.The tax cuts are financed, in turn, by the multibillion dollar reduction in Medicaid spending noted above.
According to the Kaiser Family Foundation,According to the Kaiser Family Foundation,
Medicaid itself reports that nearly two out of every three adult women enrolled in Medicaid are in their reproductive years, and that Medicaid currently finances about 45 percent of all births in the United States.Medicaid itself reports that nearly two out of every three adult women enrolled in Medicaid are in their reproductive years, and that Medicaid currently finances about 45 percent of all births in the United States.
It has sometimes been overlooked that whites make up a solid plurality, 41 percent, of Medicaid recipients; 22 percent of recipients are African-American and 25 percent Hispanic. In the four pivotal 2016 states that supported Trump I referred to earlier, whites are the majority of recipients, ranging from 58 to 67 percent.It has sometimes been overlooked that whites make up a solid plurality, 41 percent, of Medicaid recipients; 22 percent of recipients are African-American and 25 percent Hispanic. In the four pivotal 2016 states that supported Trump I referred to earlier, whites are the majority of recipients, ranging from 58 to 67 percent.
Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, described some of the AHCA changes in Medicaid in an email.Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, described some of the AHCA changes in Medicaid in an email.
Beginning in 2020, Solomon wrote,Beginning in 2020, Solomon wrote,
Along similar lines, Matthew Fiedler, a Brookings fellow, wrote me:Along similar lines, Matthew Fiedler, a Brookings fellow, wrote me:
Those placed at highest risk under these provisions, according to Fiedler, are “non-elderly adults with incomes below 138 percent of the poverty, particularly those without kids.” Many of these “childless adults” — adults without dependent children — are not actually childless but aging parents whose children are grown and do not live at home.Those placed at highest risk under these provisions, according to Fiedler, are “non-elderly adults with incomes below 138 percent of the poverty, particularly those without kids.” Many of these “childless adults” — adults without dependent children — are not actually childless but aging parents whose children are grown and do not live at home.
Just as the tax changes in the Republican bill flow to the rich, so do the health care benefits.Just as the tax changes in the Republican bill flow to the rich, so do the health care benefits.
Howard Gleckman, a senior fellow at the Tax Policy Center, found that cuts in Medicaid and new health care tax subsidies would have upwardly redistributive consequences:Howard Gleckman, a senior fellow at the Tax Policy Center, found that cuts in Medicaid and new health care tax subsidies would have upwardly redistributive consequences:
Gleckman explained that theGleckman explained that the
In March, the Congressional Budget Office evaluated an earlier version of the legislation and estimated that 24 million people would lose coverage by 2026. Most experts believe that if something like the House bill becomes law, more than 10 million people, and quite possibly many more, will lose coverage.In March, the Congressional Budget Office evaluated an earlier version of the legislation and estimated that 24 million people would lose coverage by 2026. Most experts believe that if something like the House bill becomes law, more than 10 million people, and quite possibly many more, will lose coverage.
The provisions of the House bill for those with pre-existing conditions are deliberately ambiguous. Will Doran, reporting for Politifact.com, noted that while insurers would “have to provide access to coverage for people with pre-existing conditions,” the measure “says nothing about the rates of that coverage.” As a result, the law wouldThe provisions of the House bill for those with pre-existing conditions are deliberately ambiguous. Will Doran, reporting for Politifact.com, noted that while insurers would “have to provide access to coverage for people with pre-existing conditions,” the measure “says nothing about the rates of that coverage.” As a result, the law would
The American Medical Association opposes the legislation, contending that it wouldThe American Medical Association opposes the legislation, contending that it would
From another vantage point, one with political significance, maps created by the Kaiser Family Foundation show how individuals of different ages and incomes would fare if the AHCA replaces Obamacare.From another vantage point, one with political significance, maps created by the Kaiser Family Foundation show how individuals of different ages and incomes would fare if the AHCA replaces Obamacare.
The affluent come out ahead. Older voters with modest incomes — a core element of Trump’s support — would be penalized, paying more for health coverage in almost every section of the country.The affluent come out ahead. Older voters with modest incomes — a core element of Trump’s support — would be penalized, paying more for health coverage in almost every section of the country.
The accompanying Kaiser map shows the sections of the country where a 60-year-old making $30,000-a-year would pay more (in orange) or less (in blue) in 2020. The only places where such an individual would pay less are in New York and Massachusetts.The accompanying Kaiser map shows the sections of the country where a 60-year-old making $30,000-a-year would pay more (in orange) or less (in blue) in 2020. The only places where such an individual would pay less are in New York and Massachusetts.
The consequences of the House bill, if it is enacted into law, are plain to see.The consequences of the House bill, if it is enacted into law, are plain to see.
Mark A. Peterson, a professor of public policy, political science, and law at U.C.L.A., put the case in straightforward terms in an email:Mark A. Peterson, a professor of public policy, political science, and law at U.C.L.A., put the case in straightforward terms in an email:
Benjamin Sommers, a professor of health policy and economics at Harvard’s School of Public Health, was similarly direct:Benjamin Sommers, a professor of health policy and economics at Harvard’s School of Public Health, was similarly direct:
As is always the case in legislation as complex as health care, the devil is in the details, the significance of which are often hidden from the general public. It is these details that ultimately determine the winners and the losers of any legislative program. As is always the case in legislation as complex as health care, the devil is in the details, the significance of which is often hidden from the general public. It is these details that ultimately determine the winners and the losers of any legislative program.
Henry Aaron, a Brookings senior fellow and an expert on the details, is outspoken in his criticism of the AHCA:Henry Aaron, a Brookings senior fellow and an expert on the details, is outspoken in his criticism of the AHCA:
In a harsh critique, Aaron added:
The most surprising aspect of the politics of the AHCA is that by and large the winners cast majorities for Clinton and the losers backed Trump.The most surprising aspect of the politics of the AHCA is that by and large the winners cast majorities for Clinton and the losers backed Trump.
My Times colleague Nate Cohn of The Upshot found thatMy Times colleague Nate Cohn of The Upshot found that
Affluent constituencies that cast pluralities or majorities for Hillary Clinton actually gained from the measure.Affluent constituencies that cast pluralities or majorities for Hillary Clinton actually gained from the measure.
Conservative tax reform — perhaps better described as radical tax cuts for the rich — is the very highest priority issue on the Republican legislative agenda. It is also dear to Trump’s heart.Conservative tax reform — perhaps better described as radical tax cuts for the rich — is the very highest priority issue on the Republican legislative agenda. It is also dear to Trump’s heart.
For budgetary reasons, tax legislation cannot be passed until federal health care expenditures are brought down, as Alan Rappeport of The Times explained on March 15:For budgetary reasons, tax legislation cannot be passed until federal health care expenditures are brought down, as Alan Rappeport of The Times explained on March 15:
What Trump’s support for the AHCA reveals is that when push comes to shove he is neither willing nor prepared to stand up for his working class voters. Instead, he is driven by his own self-interest. To that end, he has to accommodate the needs of House ideologues, from the Freedom Caucus to Speaker Paul Ryan, all of whom oppose spending that they see as expanding “the welfare state.”What Trump’s support for the AHCA reveals is that when push comes to shove he is neither willing nor prepared to stand up for his working class voters. Instead, he is driven by his own self-interest. To that end, he has to accommodate the needs of House ideologues, from the Freedom Caucus to Speaker Paul Ryan, all of whom oppose spending that they see as expanding “the welfare state.”
Trump’s worldview rejects the fact that the Washington swamp includes the hard right wing of the Republican Party, a faction made up of politicians who place race ahead of class and (even more than politicians customarily do) ideology before the public interest.Trump’s worldview rejects the fact that the Washington swamp includes the hard right wing of the Republican Party, a faction made up of politicians who place race ahead of class and (even more than politicians customarily do) ideology before the public interest.
After courting low-to-moderate income whites throughout his campaign, Trump has now shed that guise and aligned himself with the establishment and business wings of the party — on both health care and his proposed budget.After courting low-to-moderate income whites throughout his campaign, Trump has now shed that guise and aligned himself with the establishment and business wings of the party — on both health care and his proposed budget.
He appears headed to replicate that performance in a third arena, tax policy. Trump is deploying appeals to white identity politics in order to win approval of his massive tax cuts — the next big legislative issue on Capitol Hill. These cuts are designed to shift money up the income ladder and to reduce the size of government — to “starve the beast” or “drown it in the bathtub,” as the anti-tax radical Grover Norquist famously put it.He appears headed to replicate that performance in a third arena, tax policy. Trump is deploying appeals to white identity politics in order to win approval of his massive tax cuts — the next big legislative issue on Capitol Hill. These cuts are designed to shift money up the income ladder and to reduce the size of government — to “starve the beast” or “drown it in the bathtub,” as the anti-tax radical Grover Norquist famously put it.
In the March 23 issue of Rolling Stone, Bridgette Dunlap pointed out that manipulating racial — and now ethnic — resentment is a time honored political strategy in the United States. The “scam” Trump used, she wrote,In the March 23 issue of Rolling Stone, Bridgette Dunlap pointed out that manipulating racial — and now ethnic — resentment is a time honored political strategy in the United States. The “scam” Trump used, she wrote,
Dunlap is on target. But it’s one thing to gut regulations and change tax rates to benefit the affluent and another thing altogether to take away someone’s health care coverage. Voters who are denied medical care or find themselves unable to pay bills from doctors or hospitals are unlikely to be receptive to a campaign that seeks to “divide and rule,” no matter how receptive they may have been in 2016.Dunlap is on target. But it’s one thing to gut regulations and change tax rates to benefit the affluent and another thing altogether to take away someone’s health care coverage. Voters who are denied medical care or find themselves unable to pay bills from doctors or hospitals are unlikely to be receptive to a campaign that seeks to “divide and rule,” no matter how receptive they may have been in 2016.