Hypocrisy on Steroids: Just Let Them Die!

While the President tells us of his deep concern for Americans with preexisting conditions seeking healthcare, that there is no reason for the US pharmaceutical industry to charge Americans huge mark-ups on prescription drug well above prices charged in other developed nations and that all Americans should have access to quality healthcare, the actions of his administration and the party he supports conclusively tell us otherwise. Other than trying to require the pharmas to publish their product pricing, which has had little or no impact to reduce prescription costs, virtually everything proposed or implemented by the Trump administration and the Republican Party has resulted in quite the opposite.

By reason of GOP legislation that removed the “individual mandate” from the ACA, 20 state GOP attorneys-general have convinced a Texas federal court to declare the Affordable Care Act unconstitutional. While that judge did not issue an injunction to halt the ACA instantly, allowing the process to wend its way through the appellate courts, the GOP is still celebrating. It is eyeing a new, right-wing-dominated Supreme Court. 

GOP leaders in Congress, from former House Speaker Paul Ryan, current House minority leader Kevin McCarthy to Senate Majority Leader Mitch McConnell, have made it clear that “entitlements” (Social Security, Medicare, Medicare, SNAP {food stamps}, the ACA, etc.) are in their cross-hairs for substantial cuts in order to cure the massive deficit generated by the “it will pay for itself but didn’t” tax cuts, the largest in modern history for our richest corporate segment. Minor catch: appropriations bills must originate in the House, which now has a Democratic majority.

As Democratic “progressives” have called for extending “Medicare for all,” a uniform chorus of GOP Congressmen condemned the proposal as the kind of “socialism” that has destroyed Venezuela. And no, private insurance won’t die; such policies are often available to supplement public healthcare as most Medicare recipients already know. This is the same mantra Republicans use to oppose new higher marginal rates for those earning over seven figures a year, notwithstanding polls showing over three quarters of Americans support that tax plan. They also sort of missed the fact that government-provided/subsidized universal healthcare exists successfully in most of the developed world, from Japan, Canada and Australia to all of the European Union, without the unbridled chaos of a corrupt and inept Venezuelan dictatorship. Maybe, GOPers, just maybe, the Venezuelan disaster had nothing to do with universal healthcare and taxing rich folks.

Virtually everything that the Trump administration has done in connection with healthcare has been focused on reducing coverage, including cutting people from ACA, especially those on Medicaid. As various states, all of them red, have asked the Trump administration for statutorily permitted relief from ACA requirements (run through the Department of Health and Human Services), the HHS cannot say “yes” fast enough. Courts have been ruling, fairly consistently, that these efforts to sidestep the ACA are flatly illegal, but as soon as a court rules that way, the relevant state usually makes a minor change in its program and tries again. The ability to apply for exemptions was originally passed to allow states to provide comparable healthcare through alternative structures… not to avoid or reduce providing the requisite coverage.

For example, since the ACA forbids policies that exclude preexisting or costly conditions or place hard dollar caps on benefits, HHS has repeatedly approved so-called skinny bundle insurance that only covers what is listed in the policy. Serious ailments are simply not on the list, so technically, there is no “exclusion,” simply a non-inclusion. The policies are cheap (the claimed “benefit” by HHS)… for a reason… but fly in the face of the plain meaning of the ACA. 

The GOP also loves imposing an obligation that Medicaid beneficiaries must provide their labor in order to qualify for healthcare, a factor that sounds good to fiscal conservatives but has, in effect, ripped through impoverished communities through all age groups with heartbreaking consequences. Tens of thousands have lost access to the most basic healthcare services as a result.

The hard fact remains that if federal money is to be applied to benefit citizens who need access to healthcare, that same money is not available to pay off that nasty deficit from a tax bill that almost exclusively benefitted the rich. Thus, these conservative hypocrites, who created the deficit in the first place, need to reduce coverage, cut back social programs (even from elderly folks who have been paying into the system their entire lives), and dump as many people from as many benefits as possible … even if candidates campaigning under a GOP banner are increasingly finding voter pushback for these outrageous positions.

But the ACA has some built-in checks and balances that the Trump administration has simply ignored. “As it races to revamp Medicaid by allowing work requirements for the first time, the Trump administration is failing to enforce federal rules directing states to assess the impact of the change on low-income patients who rely on the half-century-old safety-net program, [an LA] Times analysis shows.

“None of the eight states that the administration has cleared to implement a Medicaid work requirement has in place a plan to track whether Medicaid enrollees find jobs or improve their health, two goals often touted by administration health officials.

“And nine of the 17 states that have sought federal permission to implement Medicaid work mandates have been allowed by the Trump administration to proceed with their applications despite failing to calculate the number of people who could lose coverage, according to a review of state and federal Medicaid records.

“Federal regulations issued under the Obama administration direct states seeking permission to experiment with new Medicaid policies to, in most cases, estimate effects on coverage before the initiative starts, and then independently evaluate the impact of the programs after they begin to ensure they are achieving their goals.

“Nevertheless, Arkansas, which the Trump administration celebrated in June as the first state to implement a Medicaid work requirement, still has no approved research plan, even though the state has already removed more than 18,000 people from Medicaid coverage for failing to comply with its mandate.

“‘For any new medical treatment, we require rigorous evaluation to assure it is safe and effective,’ said Dr. Benjamin Sommers, an internist at Harvard University who has extensively studied the effect of Medicaid policies nationwide. ‘We should be equally vigilant that these changes in policy are working as intended, as they could have far-reaching effects on patients’ health.’… Critics say the administration and the states appear to be systematically ignoring or weakening the requirement for independent analysis, perhaps because they fear the results.” Los Angeles Times, February 8^th. 

I remember when the GOP railed against passage of the ACA back in 2010, claiming federal administrators would effectively become “death panels” on deciding coverage parameters. Guess they never figured out that it would eventually be the entire GOP that would become a massive “death panel” for all those people who have lost or been denied coverage on programs designed to provide them with access to healthcare. Poor lives are worth less than rich lives?

              I’m Peter Dekom, and to Republicans the lives of poorer human beings are rather dramatically worth less than allowing rich folks to accelerate income inequality… on steroids.