Amid the mayhem of Trump’s first days in office, the Congressional Budget Office’s crushing report on the impact of the Republican health-care plan offers a moment of clarity. The Republican plan will deprive millions of health insurance, and raise the price for many more to pay for deep tax cuts for the rich. The math gives way to an obvious conclusion: This is the Republican mission.
Further proof will come on Thursday, when the administration is slated to present the outlines of its budget to the Congress. It will surely call for increased spending for the Pentagon and big tax cuts, all financed by deep cuts in social services for working and poor people.
The Pentagon—despite a cesspool of waste and fraud, and accounting books so convoluted that they still can’t be audited—will be showered with more money, with Trump planning a 54 percent increase.
Meanwhile, rural development, energy research, clean-water programs, preschool education, Pell Grants for college, affordable housing, Head Start—all are likely to be slashed. The State Department is slated for a cut of 37 percent; United Nations programs on health, development, peacekeeping, and more by 50 percent. The domestic discretionary budget—everything outside of Medicare and Social Security plus interest on national debt—will be cut to about half the ratio to GDP as seen under Ronald Reagan.
And as for the safety net, that’s certain to be targeted as well. House Speaker Paul Ryan, who would turn Medicaid into a block grant, as well as cap food stamps and other safety-net programs, has said, “We don’t want to turn the safety net into a hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.”
The problem is, this doesn’t work. Stripping people of health insurance puts lives at risk. Slashing domestic provision reduces opportunity, increases misery, and impoverishes our communities—from clean air and water to public schools to public parks and transportation. The rich get richer, but those that looked to Trump for help get shafted.
Trump has also launched the largest effort since Ronald Reagan to roll back regulations on corporations and privatize services. His first week featured an executive order instructing the Labor Department to block enforcement of the “fiduciary rule” on retirement advisers. The rule prohibits investment advisers from cheating their clients when recommending investments for retirement accounts, and Trump’s prompt action will ensure that they can continue to stiff their clients without fear. This will be followed by systematic efforts to weaken consumer, environmental, and worker protections. It isn’t an accident. It is what they do.
The CBO said that under the Republican health-care plan, an estimated 14 million people will lose coverage in the first year, and as many as 24 million by 2026, leaving a stunning 52 million Americans uninsured. Older workers will face rising costs with lower subsidies. Millions would be tossed off of Medicaid. Repeal of the $600 billion in taxes for Medicaid expansion and subsidies for lower-wage workers under Obamacare would benefit the already wealthy. The Center for Budget and Policy Priorities reports that the 400 richest Americans, whose average annual income is more than $300 million, would each get an average $7 million annual kickback from ending two ACA taxes. The 160 million households with income below $250,000 ($200,000 for an individual) would see no benefit.
Trump’s team dismissed the CBO conclusions, or at least tried to talk around them. Gary Cohn, the head of the National Economic Council and former president of Goldman Sachs, said, “If you want to have coverage—and we think that everyone should have coverage—we’re providing you access to coverage.” House Speaker Paul Ryan, a master at delivering mendacious message with choir-boy sincerity, said he can’t really estimate how many will lose health-care coverage: “I can’t answer that question,” he said. “It’s up to the people.”
Republicans do not consider health care a human right. They consider it a product. Their law, in its majestic equality, gives all—the rich and the poor—the right to buy the health insurance they can afford. If you decide you can’t afford it, that’s your choice.
Trump may boast that Republicans are now the party of the “American worker.” Steve Bannon can trumpet his America First propaganda. Paul Ryan can recycle his Ayn Rand free-market fantasies. Kellyanne Conway can offer her risible defense of “alternative facts.” But these are simple distractions. Republicans now run Washington, and their mission is clear.
From whatever combination of ideology and interest, they will do their best to cut taxes on the wealthy, free the corporations from accountability, and cut the services and support for working and poor people. The American Health Care Act isn’t an aberration. It’s all part of the plan.