It has been nine days since a gunman opened fire on Republican members of Congress during an early-morning baseball practice in Northern Virginia, nearly killing House Majority Whip Steve Scalise.
Scalise was only struck once, far from his most vital organs, but the bullet traversed his hip, shattering bones and unleashing concussive forces that caused severe internal bleeding and organ damage. When he was medevaced off the field, he was reportedly conscious and in good spirits. By the time he arrived at MedStar Washington Hospital Center, in the District of Columbia, he was in critical condition: unconscious, and on the brink of death.
On Wednesday, after three surgeries and a week of intensive hospital care, doctors upgraded Scalise’s condition to fair, and said he is “beginning an extended period of healing and rehabilitation.” The additional good news—such that any of this news can be described as “good”—is that Scalise is medically insured.
Before the implementation of the Affordable Care Act, members of Congress were insured through the Federal Employees Health Benefit Plan, but the ACA removed them from that system, and allowed them to spend their employer-provided health insurance subsidies in D.C.’s small-business exchange instead. Not every member of Congress took the government up on this offer. Some chose to pay full freight for insurance in their home-state market places. Others joined their spouse’s employer-provided plans. But uninsurance is not a widespread problem for people who work on Capitol Hill, which means Scalise will likely be spared the second-most horrifying consequence of his injuries: the financial cost.
Through no fault of his own, Scalise has just incurred hundreds of thousands, if not millions of dollars in medical expenses. And while he may ultimately be responsible for a tiny, tiny, tiny fraction of these costs, he and his Republican colleagues in Congress are, as he convalesces, attempting to expose millions of Americans to the kind of financial ruin he has so far avoided.
The elephant in the room since the shooting in Alexandria has been the tension between elected Republicans’ reflexive expectation that one of their colleagues receive outstanding care at essentially no monetary cost to him, and what they believe millions of other Americans should expect if they meet a similarly unlucky fate.
Because Republicans are the governing majority, they have no interest in letting Scalise’s ordeal become a symbol of anything related to health policy. I sent Scalise’s office two emails requesting redacted copies of his insurance statements when they become available—to make his total medical costs and his out-of-pocket costs a matter of public record—and received no response.
Democrats have been reluctant to politicize the shooting for different reasons: Scalise is a colleague, the dead shooter was a former volunteer for Bernie Sanders’s presidential campaign, and the media surely would have punished anyone who interrupted the Kumabaya moment on Capitol Hill.
As a consequence, one of the most vivid examples of the importance of a kind and sensible health insurance system has been cordoned off from the active, urgent debate in Congress over whether the health insurance system should be crueler and more irrational. The unveiling of the Senate GOP health care bill presents an opportunity to change that.
With some modest, but important exceptions, the Senate and House versions of Trumpcare are designed to do the same things. “From what I understand, their bill tracks in many ways along the lines of the House bill,” House Speaker Paul Ryan told reporters Thursday. “I think that’s very good.”
This is Ryan’s somewhat bloodless way of admitting that the Senate health care bill would force millions of people—disproportionately old, poor, and sick people—off of their health plans to finance a huge, regressive tax cut. The House bill would uninsure 14 million in the first year alone. It is nearly a mathematical certainty that some of those people will end up getting shot, or hit by buses, or diagnosed with cancer, and incur enormous health care bills, just like Scalise. Unlike him, none of them are likely to have their own dedicated security details, but the more important differences are that their lives will be destroyed, and they will be likelier to die.
The cruel irony is that when the Alexandria shooting occurred, Republicans were far enough along in secret health care negotiations that, in their zeal, they might end up further victimizing one of their own. The House and Senate Trumpcare bills gut protections for people with pre-existing conditions in different ways: the former by allowing insurers to price gouge sick people; the latter by allowing insurers to exclude the treatments sick people need from covered benefit schedules, creating adverse selection. Both would destabilize insurance markets for people with pre-existing conditions in at least some states. The Senate bill does not exempt members of Congress, and House Republicans have gone on record with the promise that Trumpcare will apply to them, too.
We don’t know if Scalise’s recovery will take years, or if he will need chronic care when he gets through rehabilitation. Hopefully the answer to both questions is no. But it’s dreadfully easy to imagine that if a Republican health care bill becomes law, Scalise will ultimately be uninsurable under its terms, leaving him exposed to the long-term costs of his injuries, and to the costs of other ailments that might befall him between now and when he becomes eligible for Medicare.
It is painfully obvious that Republicans would like to pretend that the issues raised by the Alexandria shooting and by their health care repeal efforts don’t overlap at all. It is just as obvious that the health and financial security of people they don’t know, or who aren’t independently wealthy, isn’t of concern to them as public officials. But a recurring theme of conservative politics in America is the discovery of empathy when consequences of right-wing policies hit home. The best thing that could possibly come of Scalise’s shooting wouldn’t be some fleeting moment of political unity. It would be pulling Republicans back from the brink of trading American lives for tax cuts.