The healthcare bill that the House of Representatives passed yesterday afternoon, in an incredibly narrow 217-to-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I can't recall what it might have been. And every member of the House who voted for it must be held accountable.
There's certainly a process critique one can make about this bill. We might focus on the fact that Republicans are rushing to pass it without having held a single hearing on it, without a score from the Congressional Budget Office that would tell us exactly what the effects would be, and before nearly anyone has had a chance to even look at the bill's actual text - all this despite the fact that they are remaking one-sixth of the American economy and affecting all of our lives (and despite their long and ridiculous claims that the Affordable Care Act was “rammed through” Congress, when in fact it was debated for an entire year and was the subject of dozens of hearings and endless public discussion).
We might talk about how every major stakeholder group - the American Medical Association, the American Hospital Association, the AARP, the American Cancer Society Cancer Action Network, the American Heart Association, and on and on - all oppose the bill.
All that matters. But the real problem is what's in the bill itself. Here are some of the things it does:
- Takes health insurance away from at least 24 million Americans; that was the number the CBO estimated for a previous version of the bill, and the number for this one is probably higher.
- Revokes the Affordable Care Act's expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans.
- Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose.
- Slashes Medicaid overall by $880 billion over 10 years.
- Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meagre tax credits pegged not to people's income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit.
- Allows insurers to charge dramatically higher premiums to older patients.
- Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.
- Allows states to seek waivers from the ACA's requirement that insurance plans include essential benefits for things such as emergency services, hospitalisation, mental health care, preventive care, maternity care, and substance abuse treatment.
- Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.
- Produces higher deductibles for patients.
- Allows states to try to waive the ACA's requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.
- Shunts those with preexisting conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and can't cover the population they're meant for. Multiple analyses have shown that the money the bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance.
- Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you'll have to document every condition or ailment you've ever had.
It is no exaggeration to say that if it were to become law, this bill would kill significant numbers of Americans. People who lose their Medicaid, don't go to the doctor, and wind up finding out too late that they're sick. People whose serious conditions put them up against lifetime limits or render them unable to afford what's on offer in the high-risk pools, and are suddenly unable to get treatment.
Those deaths are not abstractions, and those who vote to bring them about must be held to account. This can and should be a career-defining vote for every member of the House. No one who votes for something this vicious should be allowed to forget it - ever. They should be challenged about it at every town hall meeting, at every campaign debate, in every election and every day as the letters and phone calls from angry and betrayed constituents make clear the intensity of their revulsion at what their representatives have done.
Donald Trump's first 100 days: in cartoons
Donald Trump's first 100 days: in cartoons
Donald Trump's first 100 days in office were marred by a string of scandals, many of which caught the eye of the Independent's cartoonists
Trump's first 100 days have seen him aggressively ramp up tensions with his nuclear rivals in North Korea
Mr Trump has warned of a "major, major conflict" with the pariah nation lead by Kim Jong Un
Mr Trump dropped the "mother of all bombs" on alleged ISIS-linked militants in Afghanistan, amid an escalation of US military intervention around the globe
Mr Trump has been accused of falling short of the standards set by his predecessors in the Oval Office, including Franklin D Roosevelt
The tycoon's ascension to the White House came at a time when the balance of power is shifting away from Western nations like those in the G7 group
Western politicians, including the British Conservative party, have been accused of falling in line behind Mr Trump's proposals
Brexit is seen to have weakened Britain, reducing still further any political will to resist American leadership
Mr Trump's leadership has been marked by sudden and unexpected shifts in global policy
Trump's controversial missile strike on Syria, which killed several citizens, was seen by some analysts as an attempt to distract from his policy elsewhere
The President has also spent a large majority of his weekends golfing, rather than attending to matters of state
Though free of gaffes, a visit from Chinese president Xi Jinping spotlighted trade tensions between the two states
One major and unexpected setback came when Mr Trump's Healthcare Bill was struck down by members of his own party
Mr Trump has been a figure of fun in the media, with his approval at record lows
A string of revelations about Mr Trump's financial indiscretions did not mar his surge to the White House
Outgoing President Barack Obama was accused of wiretapping Trump Tower by his successor in America's highest office
The alleged involvement of Russian intelligence operatives in securing Mr Trump the presidency prompted harsh criticism
The explosive resignation of Security Adviser Michael Flynn, who lied about his links to the Russian ambassador, was just one scandal to hit the President
Many scandals, such as the accusation Barack Obama was implicated in phone-hacking, first broke on Mr Trump's Twitter feed
Donald Trump's election provoked mass protests in the UK, with millions signing a petition to ban him from the country
Donald Trump cited a non-existent terror attack in Sweden during a campaign rally
Donald Trump stands accused of stoking regional tensions in Eastern Asia
North Korea has launched a number of failed nuclear tests since Mr Trump took power
Theresa May formally rejected the petition calling for Mr Trump to be banned from the UK
When Mr Trump's initial so-called Muslim ban was struck down by a federal justice, the President mocked the 69-year-old as a "ridiculous", "so-called judge"
A week after his inauguration, Theresa May met with Mr Trump at the White House
Donald Trump's first days in office were marked by a hasty attempt to follow through on many of his campaign promises, including the so-called Muslim ban
Donald Trump's decision to ban citizens of many majority-Muslim countries from the US sparked mass protests
Revelations about Donald Trump's sexual improprieties were not enough to keep him from being elected President
British PM Theresa May was criticised by many in the press for cosying up to the new President
One of Mr Trump's top aides, Kelly Anne Conway, was mocked for describing mistruths as "alternative facts"
British PM Theresa May was quick to demonstrate that her political aims did not hugely differ from Mr Trump's
Donald Trump's inauguration, on 20 January 2017, sparked protests both at home and abroad
Perhaps this bill will never become law, and its harm may be averted. But that would not mitigate the moral responsibility of those who supported it. Members of Congress vote on a lot of inconsequential bills and bills that have a small impact on limited areas of American life. But this is one of the most critical moments in recent American political history. The Republican health-care bill is an act of monstrous cruelty. It should stain those who supported it to the end of their days.
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