Jared Bernstein | On the Economy

September 30, 2017

This will be brief, because a note about how the political debate is misleading isn’t exactly breaking news or even, admittedly, that interesting. So, I’d consider it a personal favor if you’ll allow me to vent for a moment.

It’s just that the extent to which we’re being lied to right now seems, to me at least, uniquely over the top. The transparency of the BS is just so obvious, especially on Cassidy-Graham, the just-as-bad-as-all-the-others repeal and replace bill that may get a vote in the Senate next week.

Same with the tax “plan.” Even though there is no real plan yet, what we’ve seen so far is mostly tax cuts for wealthy businesses and corporations, the cost of which will get loaded onto the deficit. Yet its proponents are selling it as a pro-growth package that lifts the working class.

My CBPP colleagues have been hammering on how C-G is just as much a wolf as past R repeal bills, despite its sheep’s clothing. It cuts health care spending on ACA functions by over $200 billion, 2020-26, and much more in later years (a new study by the health analysis firm Avalere comes up with similar numbers; see their table below) and that doesn’t count cuts to the traditional Medicaid program, which under C-G is no longer guaranteed to expand to meet the health needs of low-income recipients. Under C-G: “Faced with a recession…states would have to either dramatically increase their own spending on health care or, as is far more likely, deny help to people losing their jobs and their health insurance.”

Avalere’s estimates of cuts to states under C-G:

Years Billions
2020-26 -$215
2020-27 -$489
2020-36 -$4,150
Source: Avalere

But, because there’s no CBO score, supporters of the bill claim that these reductions in resources won’t lead to less coverage. How? For that, you need to read this jaw-dropping set of interviews from the Onion Vox. The enterprising Jeff Stein asked 9 R senators why C-G made sense in policy terms, and remarkably, they (sort of) responded. But oy, what responses! Just a rotting bag of wilted word salad.

If there was a theme to their incoherence, it was the magic of devolution to the states, as they’ll handily figure out how to do more with less (notably, the states that get dinged the most are the ones that expanded Medicaid under the ACA).

But this makes no sense at all. States must balance their budgets, so, as the CBPP quote above points out, they can’t be counted upon to meet expanded need. What C-G’s defenders call “flexibility” is actually the ability of states to reduce health care provision to low- and moderate-income people. CBPP:

…States would likely do one or more of the following: cap enrollment; offer very limited benefits; charge unaffordable premiums, deductibles, or copayments; redirect federal funding from providing coverage to other purposes, like reimbursing hospitals for uncompensated care; and limit assistance to fixed dollar amounts that put coverage out of reach for most low- and moderate-income people. As a result, many millions of people would lose coverage.

The ability to avoid such cuts is precisely why, in a federalist system like ours, you want the provision of publicly-supported health care to be nationally financed.

Unless, of course, that’s the last thing you want, which is of course what’s going on here. The majority of today’s R’s want to shrink government and give the proceeds to the rich. Their hostility to Obamacare is thus partly a function of its name, but it’s more driven by the realization that their fundamental goal is completely incompatible with a significant government footprint in health care. That’s despite the fact that every other advanced economy has long since figured this one out, and thus spends about half of what we do, per capita, while achieving universal coverage.

OK–rant over. And, trust me, I’ve been hanging around at the corner of Dysfunction Junction here in DC for a long while, so none of this is new. But especially on health care–do check out that Vox piece–the extent of the lying is worse than usual, and is a symptom of the alternative reality within which team Trump exists and which is increasingly infecting our politics.

And that can’t end well.

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