The House vote Thursday will tell us a lot about who we are as a society. Sixty times  over the past seven years the Republicans could afford to play games with their efforts to kill the Affordable Care Act (ACA), knowing that President Obama would veto their destructive behavior. Now we’re talking about real people, real money.

It’s “fake news” to say that Obamacare is a disaster. It had problems, but its flaws could have been corrected (as were flaws in Medicare and Social Security). It’s also deceptive to say Obamacare was not a bipartisan plan.  It was a conservative idea hatched by the Heritage Foundation and embraced by Republican Governor Mitt Romney, whose plan became the model for Obamacare. As syndicated columnist Froma Harrop said, “it was a bipartisan plan. It just didn’t get a bipartisan vote.”

The various Republican proposals amount to little more than voodoo economics. The President promised that he’d deliver better care at lower cost. Now the Republicans appear headed for less care at higher cost.

Over the next ten  years, their  “repeal and replace” strategy is projected to leave 24 million without health coverage, 14 million of them this year alone. Some would be without health insurance because they choose not to buy it. Fine. That’s their choice. But should taxpayers have to pay for them if they get sick and have to go to the emergency room? Mitt Romney knew a successful plan would mandates to buy insurance to discourage “free riders.”

Others won’t buy coverage due to premium increases. Some premiums will rise from $1700 to $14,600.  If you can’t afford something, choosing not to buy it isn’t a testament to marketplace free choice. Many others would lose coverage due to Medicaid cuts, among them people at the heart of Trump’s base, 60-year-olds with annual incomes of $30,000 living in rural America.  Still others would lose insurance because their employers would no longer be required to provide it.

How can supporters say with a straight face that costs will go down? Replacing subsidies with tax credits is a cruel joke for low-income people, who can’t afford to front the costs of higher and higher premiums, not to mention greatly increased co-pays and deductibles. The ACA did fail to control underlying health costs, though it significantly reduced the rate of increase in insurance costs. It didn’t do enough to incentivize young people to buy in to spread the risk. Without spreading the risk, experts, including the Congressional Budget Office, predict that premiums will go up even more rapidly than they were under the ACA. Still, the GOP plan eliminates the individual mandate, and can’t possibly be actuarially sound.

Under pressure back home, Republicans vowed to preserve protections for pre-existing conditions and allow young adults to stay on their parents’ policies.  How will they pay for it?

The American Health Care Act (call it Trumpcare or Ryancare) would cut Medicaid by hundreds of millions of dollars effective 2020 and block-grant it to the states. States would determine eligibility and benefits.  Tax credits would be age-based, not income-based, and put low-income elderly at a huge disadvantage. AARP is calling the approach an “age tax.” At the same time, higher-income Americans would get a substantial cut in the taxes that were passed to fund the Affordable Care Act. What we have here is a massive income redistribution from lower-income to the more affluent.  The proposed legislation would cut federal deficits by $337 billion, but the Freedom Caucus (the former Tea Party) thinks even that doesn’t go far enough.  Like many an operating room, there will be blood on the floor.

Thursday’s vote is the first test. The President seems happy letting Speaker Ryan struggle with this tar baby, knowing that, if the bill gets stuck in the Senate, he  can still blame the Democrats.  But it is Donald Trump who promised to provide better health care for less money. Making good on that commitment is an exercise in smoke and mirrors. And smoking, we know, is bad for our health.

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