The Republican health care effort is, like the Democratic effort before it, largely about making significant changes to Medicaid, the nation’s largest insurer. Some 20 million Americans got coverage under the Affordable Care Act, three-quarters of them thanks to the law’s expansion and promotion of Medicaid. Under Trumpcare—that is, the respective GOP plans in the House and Senate—20 million Americans or more would become uninsured largely due to massive cuts to Medicaid. This is a fact, just as it’s a fact that Republicans are cutting Medicaid to fund a tax cut for the rich.
The non-partisan Congressional Budget Office’s analysis last month of the House bill, the American Health Care Act, said, “The largest savings would come from reductions in outlays for Medicaid”—a reduction of $834 billion over 10 years, to be precise. The CBO’s analysis of the Senate bill, the Better Care Reconciliation Act, was released on Monday. “The largest savings in the federal budget,” it concluded, “would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law... By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”
Republicans are not proposing to repeal Obamacare, exactly, but to slowly starve it to death by rolling back the Medicaid expansion.
Faced with such truths, though, the Trump administration and the Republican Party are betting everything on a strategy of outright lying.
“These are not cuts to Medicaid, George,” White House advisor Kellyanne Conway told George Stephanopoulos on Sunday’s This Week. “You keep calling them as cuts. But we don’t see them as cuts. It’s slowing the rate of growth in the future and getting Medicaid back to where it was.” This proved too much even for a Republican colleague, Senator Susan Collins of Maine, who noted that the Senate bill’s failure to increase Medicaid funding to keep pace with inflation would mean people would lose benefits. “I respectfully disagree with her analysis,” Collins said on the same program. “Based on what I’ve seen, given the inflation rate that would be applied in the outer years to the Medicaid program, the Senate bill is going to have more impact on the Medicaid program than even the House bill.”
Collins is exactly right. But her candor is the exception, while Conway’s lie has become standard Republican fare. On Friday, White House press secretary Sean Spicer said that Trump is “committed to making sure that no one who currently is in the Medicaid program is affected in any way, which is reflected in the Senate bill and he’s pleased with that.” Pennsylvania Senator Pat Toomey claimed on Face the Nation that “no one loses coverage” under the GOP plan. On Fox News, Wyoming Senator John Barrasso said that “the amount of dollars going to Medicaid, from today on out, continues to go up year after year after year.” (As with Conway, these deceptive comments ignore inflation and increasing population.) Republicans in the House of Representatives have taken a similar approach to their own bill:
The Republicans have settled on a policy of deception to weather the potential political storm over the Medicaid cuts. In theory, they should face dire consequences from constituents, given that Medicaid is a broadly popular program that provides crucial assistance to millions of people, including many who voted for President Donald Trump. But their punishment is by no means assured. In fact, recent political history suggests a more disheartening possibility: Republicans’ relentless health care lies might well work, at least long enough to do massive damage to America’s most vulnerable citizens.
In the Washington Post last week, Greg Sargent cited a Kaiser Foundation poll on public attitudes toward health care. The findings were disturbing. “[O]nly 38 percent of Americans know that the GOP plan makes ‘major reductions’ in Medicaid spending,” Sargent wrote. “Another 27 percent say it makes ‘minor’ reductions; 13 percent say it makes no reductions; and 20 percent say they don’t know. If this polling is right, that means at least 6 in 10 Americans are unaware of the central feature of the GOP plan to reconfigure one-sixth of the U.S. economy, one that will impact many millions of people over time.” The poll also found that 74 percent of Republicans think their family would be better off if Trumpcare passes.
These numbers suggest how the Republicans could pull off an amazing feat of passing a much-hated bill, with provisions that will hurt their own constituents, and survive politically. Politics in America have become so tribalized along partisan lines that it’s possible to lie on a grand scale about policy and get away with it; most Republican voters will believe whatever elected Republicans say. As Post reporter Dave Weigel observed, Karen Handel’s defeat of Jon Ossoff in the special congressional election in Georgia, where Republican ads relentlessly tied Ossoff to House Minority Leader Nancy Pelosi, “only reinforces the GOP’s sense of immunity from consequences,” one effect being that Republicans “think that whatever happens w this bill—if they face angry voters—they can paper over it w Pelosi ads.” And if Trumpcare does cause misery in the coming years, everything can be blamed on Obamacare, which might convince enough Republican voters to help keep Congress under GOP control.
A contributing factor is the mainstream media’s failure to adequately cover the Republican health care effort. Senate Majority Leader Mitch McConnell wants a vote on the Senate bill this week, but most American newspapers still aren’t giving the Medicaid cuts front page attention.
While hardcore Republican voters might be fooled by the deceptive words of the Trump administration, the larger reality is that most voters, including persuadable ones, aren’t being told about potentially monumental changes on health care coming down the pike. Perhaps that will finally change thanks to Monday’s CBO score.
It’s easy to blame the Trump administration for introducing a new level of deception into American politics. Yet in many crucial ways, his administration is just perfecting longstanding Republican tactics. When supply-side economics was first promoted by fringe economists like Arthur Laffer and George Gilder in the 1970s and 1980s, it was viewed with scorn by many old school Republicans who believed in the party’s devotion to balanced budgets. The promise of supply-side economics (tax cuts that would pay for themselves) seemed like an obvious con. It was “voodoo economic policy,” as then-presidential candidate George H. W. Bush said in 1980.
But once Ronald Reagan won the nomination and the presidency, Bush and the rest of the party got on board; supply-side economics became GOP orthodoxy. Never mind that this theory failed to live up to its promises time and again: Reagan’s tax cuts were accompanied by a boom caused more by cuts in interest rates, which nonetheless led to massive deficits, while George W. Bush’s tax cuts were followed by anemic growth and high deficits culminating in a global economic crisis. “Reagan proved deficits don’t matter,” Vice President Dick Cheney famously said in 2002. “We won the midterms. This is our due.” The lesson Cheney drew from history is still GOP dogma to this day, with the current efforts at tax cuts justified on supply-side grounds. The whole sorry history shows that you can keep selling dishonest policy as long as it pleases the donor class and the ideological base of the party.
On occasion reality does catch up with lies, as the latter Bush found out when the truth became clear about Iraq’s non-existent weapons of mass destruction. But even still, Bush won re-election in 2004 and his party only started suffering electoral losses for the Iraq war in the 2006 midterms, before paying dearly in the 2008 election. And despite these losses and even after the victory of Trump, who often falsely claims to have opposed the Iraq war from the start, there is little evidence the Republican Party regrets the lies that led to the war. Indeed, with prominent Trump allies like Senator Tom Cotton calling for regime change in Iran, the only lasting lesson might be not to make embarrassing claims about WMDs but to find another casus belli.
The incentive structure for Republican lawmakers is perverse. If they lie about the consequences of Trumpcare, there is a possibility that they could get away with it by creating a new party orthodoxy, just like they did with supply-side economics. Or, at worst, they could suffer electoral defeat a few years down the road. But in the meantime, their donors would be rewarded for their loyalty with massive tax cuts. It’s no mystery why the Republicans are lying about Trumpcare: Lying pays.