Millions of Americans celebrated last week when Republican efforts to repeal the Affordable Care Act seemingly hit a brick wall. After weeks of backroom deal-making, renegotiations, and demonstrations by committed healthcare activists, three Republican senators defected from their party and pushed the latest vote to 51-49 against repeal. President Trump is already working with some senators to revive the effort, but there is a simple reason Republican healthcare reform hasn’t gone well: it has nothing to do with healthcare.
Republicans are motivated on this issue by two things. One is the appearance of success. They’ve railed against Obamacare now for most of a decade. It’s routinely referred to as a disaster and has even been compared to slavery, including just last week by Trump’s short-lived communications director Anthony Scaramucci. Trump himself made Obamacare’s disastrousness a key campaign message. After all that talk Republicans know they’ll look silly if they can’t even pass their “skinny repeal.”
Their primary motivation, though, is getting tax cuts for the rich. Under Obamacare the healthy and well-off subsidize the sick and poor. Households making more than $250,000 are taxed up to 2.35 percent on a Medicare payroll tax, and their investment income is taxed at 3.8 percent. Most drafts of healthcare reform nix those taxes, which could provide an estimated total of $247 billion in tax cuts to Americans who need it least.
Meanwhile, the nonpartisan Congressional Budget Office estimates that anywhere between 16 and 32 million Americans, depending on the iteration of the Republican bill, would be left without healthcare. This is a big part of the reason Republicans haven’t been able to pass anything – people like healthcare coverage and want the government to do more to guarantee it, not less.
Obamacare’s biggest failing is that it doesn’t go far enough to guarantee coverage. Its elements were originally conceived by the Heritage Foundation, a conservative think tank that presented its ideas as a response to a Democratic push for universal healthcare in the early 1990s. Democrats since have largely abandoned universal coverage. Their eagerness to meet Republicans halfway led to the watered-down Affordable Care Act, but the GOP has shifted so far rightward that it no longer has any meaningful healthcare proposal to offer.
Parts of Obamacare are actually extremely popular, including a requirement that insurers not refuse coverage to people with preexisting conditions. The law, and its expansion of Medicaid, has improved lives in deeply conservative states. Tomi Lahren, a young, far-right commentator and a vehement critic of Obamacare, recently expressed appreciation at the provision of the law that allows her to remain on her parents’ health insurance plan. Some GOP plans leave these provisions intact.
No free country has revoked a taxpayer-funded healthcare system. Once an entitlement has been earned, it’s difficult to take away. Contrary to Republican propaganda, such entitlements are typically not forced from above by a controlling government. They are fought for with direct democratic engagement, and protected by the same. Among the most courageous acts of activism recently were from disabled Americans, who flooded Congressional offices with sit-ins and were dragged out of their wheelchairs by capitol police for their efforts.
It may seem as though Republicans have a pathological determination to strip healthcare from as many people as possible. Trump and other Republicans have shown great contempt for poor Americans who depend on Obamacare. Paul Ryan fantasized about capping Medicaid in college. But the goal probably isn’t to kill an estimated tens of thousands of Americans who could die annually without Obamacare’s protections. Those victims are just collateral damage in the GOP’s quest to funnel more money to the richest Americans.
For proof it’s really all about tax cuts, congressional Republicans have announced their next major agenda item: tax reform. And one common feature of several GOP plans is to double the cap on tax-free health savings accounts, a perk that only benefits Americans with enough money to set aside for them. As Trump repeatedly touts the success of the stock market, which is 80 percent owned by the wealthiest 10 percent of Americans, it’s clear he’s out of touch with the majority.
Ideally, Republicans would like to undo the entire New Deal and its legacy. The single-issue agenda of the GOP is to disencumber private interests from the tyranny of social responsibility. In the case of healthcare, tyranny is taxation and social responsibility is concern for the health of fellow citizens. That’s why their healthcare overhaul attempts have been so deeply unpopular. Republicans aren’t as interested in America’s healthcare crisis as they are in ensuring their wealthy donors are asked to commit as little as possible to its resolution.