Problems with Trumpcare start with its meanness

Given that he celebrated with House Republicans in the White House Rose Garden after they passed Trumpcare, it was rather odd when President Donald Trump recently told a Fox News interviewer that the bill was “mean.” Trump was contradictory, but correct.

There is meanness in what Trumpcare would do to people’s health but it will also damage the economy and people’s dreams.

When it comes to cutting coverage, Trumpcare’s damage extends from premature babies in neonatal units to seniors in nursing homes.

President Donald Trump speaks in the Rose Garden at the White House after the House pushed through a health-care bill in May. Jabin Botsforth | The Washington Post

This looming harm made me think of Bert, a veteran and small businessman who is a relative of mine. He grew up on his family’s farm during the Great Depression until times got so bad they lost it. Bert enlisted in the Navy during World War II and would have been part of the invasion force of Japan if the war hadn’t ended. He then came home, went to college on the G.I. Bill, got married, bought a house, started a business and raised his children.

Then medical problems arose that stressed his family and finances. Bert’s wife was diagnosed with multiple sclerosis. As it progressed, Bert took on caretaking and his business suffered. Eventually his wife died in her mid-50s. As he aged, his financial cushion, hurt by his wife’s medical bills, proved inadequate. When he went to a nursing home, Medicaid — which pays the bills for two-thirds of nursing home patients — paid his.

Just in the next year, 15 million would lose insurance coverage, according to Table 4 in the just released Congressional Budget Office report on the Senate bill. Mind you, this is compared to what would happen under Obamacare. In the next 10 years, 22 million would lose coverage and losses would continue to rise because Medicaid would be inadequately funded. Premiums for older low- and middle-income Americans would rise sharply.

Under the Senate’s version of Trumpcare, plans could be sold that don’t cover expensive treatments. If someone was in the hospital and missed an insurance payment, they would lose coverage for six months. Caps on coverage in some states would bring back the pre-Obamacare system in which some cancer patients lost coverage right in the middle of chemotherapy.

If Trumpcare was signed into law, people wouldn’t just suffer financial harm from big bills. Some would die because they didn’t get a screening or a treatment. That’s reality, not rhetoric.

A Tennessee study found Medicaid cutbacks were associated with higher rates of breast cancer and a New England Journal of Medicine review of many studies showed coverage saves lives.  Beyond Medicaid cuts, which affect seniors, the disabled, children and low income adults, Trumpcare also cuts help for people buying private insurance.
Beyond that meanness, Maine’s economy would take a big hit. An analysis by the Maine Center on Economic Policy found that Trumpcare would cause 10,000 jobs to be lost, in part because  rural hospitals would be under great strain and some would close.

Trumpcare also threatens freedom of opportunity. According to the Center for Law and Social Policy, Medicaid cuts would strain state budgets. This “would severely harm college students twice — denying health insurance to millions of students in postsecondary education and forcing policymakers to fill the enormous Medicaid holes in their state budgets by decreasing funding for public colleges and universities.” Many people think students can just stay on their parents’ plans but not all parents have coverage now and fewer would if Trumpcare passed.

White House advisor Kellyanne Conway’s suggestion that able-bodied adults who qualify for Medicaid can get a job with health benefits ignores the reality that many jobs don’t come with health insurance. Some using Medicaid are self-employed and Trumpcare would thwart these entrepreneurs.

Now Trumpcare’s fate lies in the Senate as the House of Representatives is likely to adopt whatever the Senate passes. Rep. Bruce Poliquin voted for Trumpcare once already, before hearing how many would lose insurance.  His Bangor office then became literally less accessible to constituents.

In contrast, Sens. Susan Collins and Angus King oppose Trumpcare. On Monday evening, Collins announced her decision, pointing to big coverage losses, damaging Medicaid cuts and harm to rural hospitals. Collins’ opposition is well-placed because these are fundamental flaws with the legislation, which is more than mean.

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Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.