- John McDonoughprofessor at the Harvard T.H. Chan School of Public Health.
- Dr. Steffie Woolhandlerprofessor at CUNY-Hunter College and co-founder of Physicians for a National Health Program.
After weeks of secret deliberations, Republican senators released a healthcare proposal that would remove millions of low-income and disabled people from Medicaid, prompting protests on Capitol Hill that are expected to continue throughout the country. The bill would also cut subsidies to purchase health insurance, allow states to effectively eliminate protections for people with pre-existing conditions, and defund Planned Parenthood for a year. It was negotiated behind closed doors between 13 Republican male senators. We get response from Harvard professor John McDonough, a chief architect of Romneycare who also worked on the development and passage of the Affordable Care Act, and speak with Dr. Steffie Woolhandler, a key advocate for Medicare for All.
AMY GOODMAN: After weeks of secret deliberations, Republican senators Thursday released a healthcare bill that would reduce key benefits for millions of Americans. The Better Care Reconciliation Act would fund a large capital gains tax cut for the rich by removing millions of low-income and disabled people from Medicaid. According to the Center on Budget [and] Policy Priorities, $33 billion of the tax cuts would benefit the 400 wealthiest U.S. households. The Senate bill would also reduce subsidies to individuals to purchase health insurance, and would allow states to eliminate protections for people with pre-existing conditions. The measure would defund Planned Parenthood for a year, making breast cancer screenings and basic reproductive services more difficult for women to secure.
While drafting the legislation, President Trump had called on Republicans to improve the House plan by giving it more, quote, “heart.” The bill was negotiated behind closed doors between 13 Republican white male senators. This is Senate Majority Leader Mitch McConnell.
SEN. MITCH McCONNELL: We agreed on the need to free Americans from Obamacare’s mandates. And policies contained in the discussion draft will repeal the individual mandate, so Americans are no longer forced to buy insurance they don’t need or can’t afford; will repeal the employer mandate, so Americans no longer see their hours and take-home pay cut by employers because of it.
AMY GOODMAN: Senator McConnell says he wants to vote on the healthcare bill next week, before Congress leaves for the Fourth of July recess. Republicans can only afford to lose two votes for the measure to pass with 50 votes. Four Republican senators—Rand Paul, Ted Cruz, Ron Johnson and Mike Lee—said Thursday they’ll oppose the bill in its current form, arguing it fails to cut Medicaid benefits enough. The bill is similar to a House measure that would leave more than 20 million Americans without health insurance. The Congressional Budget Office has yet to score the Senate bill. Democrats are firmly united against the bill. This is Senate Minority Leader Chuck Schumer.
SEN. CHUCK SCHUMER: This is a bill designed to strip away healthcare benefits and protections from Americans who need it most, in order to give a tax break to the folks who need it least. This is a bill that would end Medicaid as we know it, rolling back Medicaid expansion, cutting federal support for the program even more than the House bill, which cut Medicaid by $800 billion.
AMY GOODMAN: This comes as scores of disabled protesters held a sit-in outside Senator Mitch McConnell’s office on Capitol Hill Thursday and demonstrators gathered at Washington, D.C.’s National Airport to target Republican lawmakers as they left town for their home states.
Also on Thursday, Barack Obama weighed in on efforts to scale back his signature healthcare law. He posted a scathing statement on Facebook that said, quote, “The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America,” President Obama said.
For more, we host a roundtable discussion with three guests. Joining us from Boston, John McDonough, professor at Harvard Chan School of Public Health, served as a senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor and Pensions from 2008 to 2010. And from 2003 to '08, he served as executive director of Health Care for All in Massachusetts, playing a key role in passage of the 2006 Massachusetts health reform law. He's the author of Inside National Health Reform.
Also in Boston, Dr. Steffie Woolhandler joins us, a professor at CUNY-Hunter College and a primary care physician. She’s a lecturer at Harvard Medical School and the co-founder of Physicians for a National Health Program. She is a well-known national advocate for Medicare for all.
And in Aspen, Colorado, we’re joined by Dr. Willie Parker, physician, abortion provider, and board chair of Physicians for Reproductive Health. His new book, Life’s Work: A Moral Argument for Choice.
We welcome you all back to Democracy Now! Let’s begin with Professor McDonough. Can you lay out what the Republicans presented, after weeks of secret negotiations with other Republicans?
JOHN McDONOUGH: So, I think that the statements from Senator Schumer articulated it well. What is essentially going on here is the Affordable Care Act was an attempt to improve the nation’s healthcare system and expand coverage and deal with other issues. And it was paid for significantly by new taxes on wealthy Americans and some very powerful corporate interests. The new bill in the House, and reflected in the Senate, is an attempt to do major tax cuts for wealthy Americans and powerful corporate interests, financed by decimating the Medicaid program and other essential parts of the nation’s healthcare safety net. So, that is clearly what’s going on.
The Senate initially said, “We will take the House bill and throw it away and start all over.” Instead, what they’ve done is simply make a number of adjustments. If you look up close between the two, you can see many, many disagreements and differences of opinion on details, but if you stand back, they are essentially the same thing.
They fundamentally undermine the nation’s commitment to the Medicaid program, which covers about 75 million low-income and lower-income Americans by phasing out the expansion that was created in the Affordable Care Act and by fundamentally changing the financing of it, where they put a cap on it so that states will have no choice but begin to retrench back on the benefits. They continue the subsidies for private health insurance purchase for lower-middle-income Americans, but, again, they substantially degrade that coverage—for example, lowering the—what’s called the actuarial value, or how much benefit you get out of your premiums, from the ACA standard of 70 percent down to 58 percent, which means higher copays, higher deductibles, across the board. They defund Planned Parenthood for a year, but setting it up then to continue well into the future. They get rid of the Prevention and Public Health Trust Fund that has provided vital public health funds to the Centers for Disease Control as well as public health departments all over the country. You can go on and on. It’s hard to find something in the measure that one could say that’s good or at least not harmful. It’s pretty much bad from start to finish.
AMY GOODMAN: On the issue of Medicaid, we’re talking about Medicaid cut, overall, in half, something we haven’t seen in the history of Medicaid, both Medicaid expansion and Medicaid itself. And can you talk about who is covered by Medicaid? Like half the babies born in this country are paid for by Medicaid.
JOHN McDONOUGH: Yeah, so, Medicaid is the primary insurance coverage program for low- and lower-income Americans, many children, most children in the United States—more children under Medicaid than any other kind of coverage—their parents, poor senior citizens, low-income disabled people and other working low-income adults, who have no other options for coverage. About a third of the Medicaid program consists of low-income senior citizens and disabled. They actually account for two-thirds of the spending on the program. And so, if you want to take a meat ax, which is what they’re doing, to the Medicaid program, it is really impossible to implement cuts at that level without having damaging impacts on low-income, disabled and elderly, as well as children, parents and families.
AMY GOODMAN: Nursing homes?
JOHN McDONOUGH: Nursing homes is very much a part of the benefits that low-income seniors get. Very few families have had seniors, grandparents or parents, who have gone into long-term care and not at some point needed help from Medicaid to pay for the cost of long-term care, which is just so unaffordable for most Americans.
AMY GOODMAN: Dr. Steffie Woolhandler, presumably, you only saw this starting yesterday. This was kept under wraps from many Republicans, as well as Democrats, in the Senate. And it’s interesting, the Republicans who are opposed to this. You have the group, like Mike Lee from Utah and Rand Paul from Kentucky, Ron Johnson from Wisconsin, who don’t—who feel that this doesn’t go far enough. But then you also have Senator Susan Collins from Maine, as well as Senator Murkowski from Alaska, who are deeply concerned that this, well, once again, as with the House bill, that apparently President Trump has called “mean,” will mean tens of millions of more Americans will lose their health insurance.
DR. STEFFIE WOOLHANDLER: Well, it certainly will. I think it’s very important for people to express their views on this bill to the senators, because there will be a vote next week.
You know, it is, of course—this bill, of course, is quite a bit meaner in some ways than the House bill. The cuts to Medicaid, for instance, are much deeper. And many people, like those in nursing homes and poor infants, are going to be affected worse. There’s going to be worse problems under this bill.
But I do want to just talk a little bit about how the taxes are—these big tax windfalls are going to come to the rich. What the Republican bill does is says that rich people who get their income from investments no longer have to pay the Medicare tax. People who earn in wages and salaries have to pay a 3 to 4 percent Medicare tax. But the Republican Senate and House bills will say that rich people earning $100 million a year off of investments, through stock sales and dividends, no longer have to pay that same Medicare tax that the rest of us pay. They’ve been very quiet about that, because I don’t think that’s a very popular idea. You know, additionally, they’re cutting taxes on the insurance industry, on Pharma, as if they needed more money. They’re cutting taxes on the medical device industry. So this is a giant tax cut, a very unpopular tax cut, if Americans really understood who was getting this tax windfall. And it’s going to make healthcare skimpier and more expensive for ordinary Americans.
AMY GOODMAN: Professor John McDonough, does this void Obamacare altogether, if this were passed?
JOHN McDONOUGH: If it were passed in its current form, it would do unprecedented damage to that law, most of the major portions of it that deal with expanding coverage and providing some security for Americans in terms of needing healthcare services. There are other major parts of the law that it actually doesn’t touch at all. There’s a big part of the law that’s trying to do major changes in medical care delivery, creating new mechanisms called accountable care organizations, establishing a center for innovation at the Centers for Medicare and Medicaid Services. None of those are touched, so there’s large parts of the law that, quietly, Republicans actually support and seem to want to continue and even expand. But the major pieces of the law, in terms of expanding insurance coverage for low- and lower-middle-income Americans and the taxes to pay for that, are pretty well decimated in terms of what’s on the table right now.
And this is going to move very fast. It’s possible that it won’t happen. And that’s why Steffie is so correct when she says everybody’s got to weigh in here. But if they succeed in getting it through the Senate on Thursday or Friday of next week, there are some reports that the House may actually convene on Saturday and adopt the Senate version and send it to the president’s desk. So this could move with unprecedented rapidity for such a major controversial issue. So the stakes are very high. And the place really where this needs to get stalled and defeated is next week in the Senate.
AMY GOODMAN: So are you saying that this actually could go to the House—instead of the House attempting to reconcile the Senate and House bills, they could just adopt the Senate bill?
JOHN McDONOUGH: It is conceivable that, you know, if it gets through the Senate with 50 votes, that the Senate will say to the House, “This is it, folks. Take it or leave it.” And they will come on Saturday, and they may be able to string together enough votes so that they could actually just adopt the Senate plan in toto and send it directly to President Trump’s desk.
AMY GOODMAN: You were one of—
JOHN McDONOUGH: So, this could happen very fast.
AMY GOODMAN: You were one of the architects of Romneycare in Massachusetts, right?
JOHN McDONOUGH: We didn’t call it that.
AMY GOODMAN: Well, the Affordable Care Act very much based on a Republican plan, under a Republican governor of Massachusetts, Governor Romney, who would later, obviously, run for president. How far away are the Republicans today in Congress, in the House and the Senate, from that Republican plan in Massachusetts that did get passed?
JOHN McDONOUGH: Well, there’s a—there’s a significant withdrawal. As we know, the individual mandate was a Republican conservative idea, going back to the 1980s. The '90s, that was their alternative to Bill Clinton's universal coverage plan. And they continued to promote it throughout the process where we passed it in Massachusetts. And then, when it got to Congress in 2009 and it was Barack Obama who was supporting it, then they all jumped off the ship and left the Democrats there by ourselves to try to get as best done as it was possible to get done at that time. So, there’s been a substantial retrenchment.
And what’s left is—I saw, you know, this morning, on one of the TV shows, Senator Rand Paul basically saying, “Well, I think we should just take away all of the standards and requirements and let people buy whatever they want. And people should be able to buy health insurance,” he said, “for about a dollar a day”—so, about $365 a year. I don’t know what that would really get you, but it wouldn’t get you very much.
But I think that one has to understand is what motivates the Republican Party is cutting taxes. That’s first, and everything else is secondary to that goal, whether it’s healthcare, education, environmental protection—everything else. So this is part of a bigger pattern in terms of the Republican agenda. It’s just this is so big and important, this is up first. But this is not the end. This is just the beginning.
AMY GOODMAN: John McDonough, I know you have to leave. I want to thank you for being with us, professor at Harvard Chan School of Public Health. Dr. Steffie Woolhandler will stay with us. And we’ll be joined by Dr. Willie Parker, who’s chair of the board of Physicians for Reproductive Health. He is an abortion provider himself. And we’ll talk specifically about what this bill will do to Planned Parenthood. Stay with us.