In June 2015, I wrote about RaDonna Kuelkelhan, a 59-year-old woman from southeast Kansas who was fighting to get health care. A treatment for larynx cancer caused a series of collateral problems that made it hard for RaDonna to eat. Her doctor was unable to treat the problem aggressively because she had no insurance, so RaDonna was wasting away, slow-walking toward an avoidable death.
Her corner of the state is one of the poorest and sickest regions in Kansas. It is also overwhelmingly white and deeply conservative—Trump country. I met few people in the area who thought politics played a role in why they couldn’t afford health care. One clinic administrator told me that her patients had been poor for so many generations that they just considered bad health care an intractable fact. Problems like RaDonna’s inability to qualify for Medicaid were attributed to government incompetence rather than political ideology.
Not long after The Nation published that story, RaDonna died. Toward the end, her family was fighting to get her on Medicaid only so that she could die with dignity, in a hospice. As RaDonna’s doctor told me prior to her death, “It’s so hard to be the doctor who has to reveal, ‘I’m not giving you a death sentence by telling you you have cancer—I’m giving you your prognosis because you don’t have coverage.’”
Many more doctors will know this horror if House Speaker Paul Ryan and President Donald Trump succeed with their health-care “reform” plan. Many people who read RaDonna’s story reacted to it with a sort of detached pity, even judgment: How could those poor fools in Kansas support politicians who sentence them to untreated illness and death? Well, we’re all in Kansas now.
Ryan’s American Health Care Act (AHCA) has rightly been called a tax break for the wealthy masquerading as reform. But it’s much more than that—it’s a vehicle for Ryan and other traditional, pre-Trump Republicans to achieve their decades-old goal of taking apart the Great Society. They colluded with neoliberal Democrats to end welfare, defund public education, and deregulate a predatory financial industry in the 1990s and 2000s. What’s left now is Medicare, Medicaid, and their promise that no American is too poor to get health care. Ryan’s bill would unambiguously end that promise.
The AHCA’s repeal of the Affordable Care Act’s “individual mandate” is the least of it. Ryan would not just halt Obamacare’s Medicaid expansion; he would shrink it by at least 14 million people over the next decade, according to the Congressional Budget Office. Given the sweeteners with which the administration is enticing far-right lawmakers, even that estimate is likely too rosy.