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The results are in / March 15, 2017
Okay students, test time is up. Put down your pencils and turn in your work. Well, whaddaya know — your grades are back already. Let’s see how everyone did.

You first, Mr. President. We were curious to see how you’d do on your health care policy exam, so we brought in the Congressional Budget Office to review your answers. Woo boy. We’ve got some good news and bad news. The good news is you didn’t receive an “F.” The bad news is that CBO gave a grade that’s even worse — the equivalent of a flaming bag of whatever it is that the kids deposit on your doorstep Halloween Night. Pull up a chair and let’s go over some things. Same goes for your supporters.

From Politico this week: “Roughly 24 million more people would be uninsured over a decade if the House Republican Obamacare repeal bill is enacted, according to a much-anticipated Congressional Budget Office analysis that could threaten GOP hopes of getting the measure through the House. The legislation would lead to 14 million more people being uninsured in 2018 alone. The nonpartisan score-keeping office also forecasts the GOP plan would cut the deficit by $337 billion over a decade, primarily because of its cuts to Medicaid and private insurance subsidies.”

My word: 14 million people losing their health insurance next year, and 24 million within the decade! Even for the national Republican Party, this is an impressive display of skill in ruining people’s lives.

Narrowing the focus to rural areas such as our own, The Washington Post looked at what would happen under the House bill that President Trump, Speaker Paul Ryan and rank-and-file conservatives want to enact into law: “Some of the harshest consequences of the GOP’s health bill would fall on rural Republican strongholds — precisely the voters who helped elect Trump. Among the counties where Trump won his biggest victories, nearly all would face deep cuts in tax credits under the Republican plan to replace Obamacare. And, in the parts of the country that would lose the most in tax credits, a majority of voters were Trump supporters.”

Just to explain, in a short paragraph or less, why Trumpcare/Ryancare is so bad, it removes income as a factor in determining the share of tax subsidies going to working- and middle-class Americans to purchase insurance, with the financial impact generally worsening with age. Then it passes the savings on to the wealthiest (and usually healthiest) people in the country. To top it all off, the bill hammers Medicaid to the tune of $880 billion-with-a-B over the next decade. Who needs a safety net, anyway?

And there’s this, from The Week's Damon Linker: “Yes, it’s bad to pass legislation that hurts millions of people. But you know what’s worse? Passing legislation that stokes anger and resentment that could, in turn, end up blowing the whole system sky high. That’s what Trump is doing by supporting this sadistic bill. He’s risking cutting his own supporters loose, in search of a new, even more radical tribune who will finally put their interests first, no matter how many rich donors stomp their feet like spoiled children and channel cash to the Ryan wing of the GOP.”

Go ahead, dismiss the Congressional Budget Office analysis and the rest as fake news if you want. Just hope like heck that the GOP’s signature “American Health Care Act” never becomes law. Because the facts won’t seem so fake when they bite you in your bank account.

Of course, it must be conceded that health care is an enormously complex issue, as even our Twitter-tantrummin’ president allows. “Nobody knew health care could be so complicated,” Donald Trump stated in late February, an observation wherein “nobody” is properly interpreted to mean “everyone.” Fact is, it’s impossible to design health care legislation that doesn’t produce winners and losers. In the interest of transparency and fairness in evaluating Trumpcare/Ryancare, let’s first take a look at the winners under the AHCA, which I propose should be renamed the PAIN Act (“Prevent Anyone’s Insurance Now”). Remember, this is the legislation that Trump has hailed as “wonderful” and “a solution that’s really, really I think very good.” (Another Trump promise: “We’re going to have insurance for everybody.”)

From “If there is anyone who does well under AHCA, it is mostly Americans who are younger and middle-income …. Under Obamacare, a [21-year-old who earns $68,200 annually] earns too much money to qualify for financial help to purchase insurance. The GOP plan, however, gives tax credits to anyone who earns less than $75,000 — meaning this person would receive $2,450 to help buy coverage. The plan would be a bit skimpier than those offered under Obamacare, but it would also be a whole lot cheaper.”

Timeout for just a minute: How many 21-year-olds in Halifax County earn $68,200 a year? Anyone? Okay, let’s move on to other winners — notably the Republican “base”, i.e. folks who would reap big tax gains from the repeal of Obamacare’s revenue-generating provisions. Who are these people? According to Reuters, the answer is the ultra-wealthy: households with annual incomes of at least $3.9 million would benefit “at more than five times the rate for middle-income families, according to the nonpartisan Tax Policy Center,” the wire service reports. Reuters interviewed Howard Gleckman, a senior fellow of the research center who has run the numbers. “The effects are really very dramatic,” he told Reuters. “We found that a typical middle-income family would get a tax cut averaging about $300, while people in the top 0.1 percent would get a tax cut of about $207,000.”

To add further insult to injury, the House bill removes a cap on tax deductions that health insurance companies can claim on the salaries of their their highest-paid executives. The Affordable Care Act (“Obamacare”) limited the tax exemption at $500,000 per executive. By lifting the limit, the Republican bill delivers a sweet kiss to the insurance industry that’s worth an estimated $400 million over ten years. In other words, all other taxpayers will have to dig a little deeper in their pockets to fund the government so Aetna and Anthem executives can spring for that third home.

Meantime, let’s look at a prototypical loser under the American Health Care Act. The Wall Street Journal (owned by Rupert Murdoch!) presented a scenario that might resonate in areas such as our own, examining what the AHCA would do for a 62-year-old rural Nebraskan who earns about $18,000 a year and is still a few years away from qualifying for Medicare. “In extreme cases, the amount a consumer might owe for a [health] plan could exceed that person’s annual income,” reports the WSJ. Because health care becomes more expensive with age, and treatment in rural areas generally costs more due to lack of competition and scarcity of providers, the aforementioned 62-year earning $18,000 “could pay nearly $20,000 annually to get health-insurance coverage under the House GOP plan — compared with about $760 a year that person would owe toward premiums under the ACA ….”

No wonder Avik Roy, a conservative health policy wonk (although I’m not sure such creatures actually exist) penned these words in that noted Marxist rag, Forbes magazine: “Expanding subsidies for high earners, and cutting health coverage off from the working poor: it sounds like a left-wing caricature of mustache-twirling, top-hatted Republican fat cats. But not today.”

What’s going on here? Only what we’ve been saying ever since Donald Trump embarked on his strange mission to become president: The man is an utter and complete fraud. Because Trump will say anything, and because there are lots of people in the world who really do need to hear it from the pitchfork brigade — in Washington, on Wall Street, and yes, in the media — lots of folks saw in him the possibility of a different kind of politician, one who could cut through the gridlock and posturing and elite self-regard to get stuff done. But the defining characteristic of Donald Trump’s public (and private) career has been a penchant to skate, unaccountable and unconcerned, when everything else around him is collapsing. Trump’s act evidently can withstand the rigors of the campaign trail, as the results in November attest. It doesn’t work so well when you are President of the United States and the fate of your countrymen — and the world — rests in your hands.

Trump’s policy idiocy and instinctive cruelty and meanness would be nothing more than material for the next episode of “The Apprentice” if not for the cravenness of the Republican-controlled Congress and enablers in the conservative movement. What’s 5th District Congressman Tom Garrett up to these days? Garrett’s latest constituent column, posted on his official website and dated Feb. 27, had to do with the congressman’s recent visit to the German Bundestag. (Garrett did write a new column last week for 5th District newspapers, although it had nothing to do with the topic of the hour, health care.) What’s wrong, congressman? Cat got your tongue? Or just too busy? (That I could sort of understand.) Garrett did write a column three weeks ago about his sponsorship of an alternative GOP health care bill, championed by Kentucky Senator Rand Paul, that would actually be worse than the steaming mess served up by Speaker Ryan and the White House. On his website, Garrett directs readers to the “Obamacare Replacement Act” so they can see the details for themselves, but as of this week, when you click on the link to pull up the legislation you come up with “Page Not Found.” Oh, the irony.

So here we are, two months into the Trump Administration, and the entire government feels like a broken link — the natural outcome of placing faith in this charlatan’s promises to “Make America Great Again.” Personally, I think the Obama administration’s success in extending health insurance to 20 million people was (and is) pretty great. Because clearly America is capable of doing all sorts of positive things with competent and caring people in charge. Now that they’re gone, the folly of placing trust in this scam artist and his merry band of blinkered ideologues should be clear. Just ask the good folks at the Congressional Budget Office.

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