DUMBBELL HEALTHCARE POLITICS: The HCA and AHCA

It is health that is real wealth and not pieces of gold and silver. ~ Mahatma Gandhi 

“Dumbbell” politics is roiling America. Dumbbell politics is now present as two widely dissimilar healthcare policies are being espoused by equally widely-separated parties who aren’t interested in reaching any sort of middle-ground that most people can literally live with. Like a dumbbell, this one has a weight on the left-side that’s opposite to the weight on the right, connected across the US by a thin rod.

The latest example of dumbbell politics involves healthcare. On the far left is Sacramento, California and on the far right Washington, D.C. that are separated by more than just 2,733 miles as the digital crow flies. Either one of these weighty policies will be a very heavy lift. Dumbbell politics in healthcare policy involves much more than a shocking misdemeanor assault in the Nebraska portion of the rod. It involves every breathing person who uses healthcare and wants to maintain or improve his or her health. It’s a matter of health and life for all 326 million of us.

First, the left-wing dumbbell weight in California. Last week California State Senators Ricardo Lara and Toni Atkins introduced SB-562, the Healthy California Act (HCA), to their Democratic colleagues, who hold a supermajority in the legislature and to their outnumbered Republicans. Sen. Lara’s Appropriations Committee easily passed this bill that would completely revamp California’s healthcare market into a “single-payer,” state-financed universal healthcare system for every documented and undocumented resident. Progressives and many liberals were joyously beside themselves. There are commendable aspects of this legislation, but totally re-doing our state’s healthcare system would be very expensive and very disruptive. Indeed, some of SB-562’s proponents’ happiness should have diminished after the committee estimated the costs of implementing such a fundamental restructuring, a fiscally injurious $400 billion per year. For perspective, the State of California’s total budget for everything it provides to us 39.5 million citizens will be $183.4 billion in coming fiscal year. SB-562 would compromise the fiscal health of California. Do you see a problem?

Sen. Lara apparently doesn’t. He wants to have his dumb-bill quickly passed – by tomorrow – before his fellow senators and assemblymen figure out how the state will actually pay for California’s version of Medicare for All. Few if any Sacramento Democrats can remove his or her very rose-tinted glasses about SB-562’s costs, disruption or consequential public pain. The political principle of single-payer healthcare seems more important than its costs and who they are imposed on. Sen. Lara’s perverse desire for haste in passing this giant change to California’s healthcare system strangely parallels the Congressional Republicans’ rush to pass their AHCA without any public hearings.

The California Appropriations Committee’s fiscal assessment assumed two illusions: first, a new 15% payroll tax would be implemented on every Californian’s wages, in addition to adding other new taxes as sources of required funding; second, the state would continue to receive the same transfer funding from Washington for Medicaid. Sen. Lara hasn’t apparently gotten the ubiquitous message that the president’s just-issued federal budget proposal will amputate Medicaid funding — the national umbrella for California’s Medi-Cal program — by $616 billion over 10 years plus $834 billion of Medicaid reductions in the Republican health care legislation (see below). Sen. Lara seems to have a serious case of real money illusion, something that isn’t cured by an optometrist.

Governor Jerry Brown hasn’t stated whether or not he’s in favor of SB-562. Being Jerry Brown, he offered a Latin phrase to describe his concerns, ignotum per ignotius, which translates to "the unknown by the more unknown." In less esoteric, more modern language, you have a problem (say, healthcare) and state, “I’m going to solve it with something that’s even a bigger problem.” Oops.

Now to the right-wing dumbbell weight in Washington that serves as a mirror-image of Sacramento’s left weight. Because Republican Congressional leaders’ primal goals for the past 7 years have been to void President Obama’s Affordable Care Act and reduce the tax burden of already rich/wealthy Americans, the Republican House of Representatives sprinted and passed their AHCA (American Healthcare Act) at near Olympic pace. The AHCA passed without public hearings or, for most Republicans, even reading the bill before their vote. This dumb-bill is now in the hands of people like Senator Mitch McConnell.

It is important to remember that the AHCA is legislation whose epidermis has something to do with healthcare, but its skeletal core provides several means for giving rich people a considerable tax cut. For Republicans, the most important number from the Congressional Budget Office’s (CBO’s) assessment of the AHCA is the expected reduction in the federal budget deficit, not the more publicized healthcare-related predictions. The CBO estimated that the Act would reduce the deficit by $119 billion over 10 years. This deficit reduction forecast will allow Sen. McConnell and Rep. Paul Ryan to offer tax “reform” legislation that’s heavily skewed to benefit the rich/wealthy. The AHCA’s prime purpose has much less to do with wounding our healthcare system; it has far more to do with ultimately reducing taxes for the 1%. These tax reductions have been estimated to be an unhealthy $1 trillion.

The AHCA’s healthcare consequences have been widely reported: 23 million people could lose healthcare coverage; it could destabilize individual insurance markets in some states; states would have to option to reduce the scope of coverage; people with pre-existing conditions will be paying much higher premiums, if insurance is available at all; and Medicaid enrollment would drop by 14 million principally due to increased premiums and lower funding.

Trumpcare’s potential winners would include people who are young, healthy and earn higher incomes. The far more numerous losers would include poorer Americans who use Medicaid, and older and/or lower-income people who buy their own insurance. Like folks who voted for the president.

The D.C. dominant Republicans have been obsessed with changing federal healthcare policy. The AHCA is a mutant tumor that will cast millions of people into slithery swamps of murky uncoverage to fend for themselves in the name of tried-but-untrue Republican fiscal policy. In sum, the AHCA would be a very unhygienic act of Congress. Republican Representatives and Senators don’t care about the health consequences; they’re in this solely for their other, misguided principles. No wonder I’m feeling ill.

These two dumb-bills comprise an injurious political dumbbell. With this West-East healthcare dumbbell, we’ll need to appeal to Asclepius and Ianuaria to see us through with our individual and collective health hopefully intact and somehow resist Washington’s growing kakistocracy.