Editorial Law and Policy

Your Money or Your Life? The GOP Wants Both

Jodi Jacobson

Republicans' tax bill would immediately endanger the health, well-being, and, literally, lives of millions. In sum, people will die.

A tax heist. A tax scam. Tax deform. An act of legislative looting. The Trump Family and Friends Tax Cut.

These are some of the descriptions analysts are using to describe the bill the Trump administration, along with the U.S. House and Senate GOP, has tried to sell as “tax reform.” Passed in the wee hours of December 2 in a frantic effort by Senate Republicans to prevent the public from knowing what it said, what it would cost, or whom it might hurt most, the bill promises a massive redistribution of wealth and power from the working poor and middle class to the 1 percent of the 1 percent—the wealthiest people in this country. It would immediately endanger the health, well-being, and, literally, lives of millions. In sum, people will die.

For example, the bill eliminates the individual mandate in the Affordable Care Act (ACA). The Congressional Budget Office (CBO) estimates doing so will result in 4 million people losing insurance coverage over the next year, and will leave 13 million fewer people insured over the next ten years. Premiums will rise—as much as $2,000—because without the mandate, there will be fewer healthy people participating in the risk pool, causing premiums to go up for those who are ill or have pre-existing conditions. Earlier this year, Republicans tried to gut the ACA in the open, but that was so unpopular, they had to resort to stealth maneuvers. Hence the “tax bill,” which includes all the poisons in the GOP’s kitchen sink.

The bill gives massive tax cuts to millionaires, billionaires, and corporations. Estimates by the Tax Policy Center (TPC) indicate that by 2027, 62 percent of the total tax cuts realized will go to the richest 1 percent in the United States. TPC also estimates that the bill will raise taxes on 87 million middle-class families (defined as those making under $200,000, including 67 million making under $100,000). The bill shortens the time on real estate depreciation in what’s been described by former George W. Bush speechwriter Ned Ryun—a conservative with whom I more often than not disagree vociferously—as a “major gift to billionaire real estate owners,” which will cost the U.S. Treasury hundreds of billions in revenue between now and 2036. “Who benefits from this?” Ryun asks. “Literally a handful of real estate billionaires.” Where might those tax revenues otherwise go? Roads, bridges, schools, clean water, public transit, and health care, to name just a few of the urgently needed public investments in this country. 

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Some of the implications are yet to be understood. In fact, the bill was rushed through so quickly that many senators did not know what was in it when the vote was called. Well into the night, amendments were being written on the fly and sent to Senate offices by the very corporate lobbyists to whom Republicans in the House and Senate have admitted they’ve sold their souls. And as Eric Levitz writes in New York magazine, they moved so fast they “also, accidentally, nullified all of their corporate donors’ favorite deductions.”

Whoops. 

That mistake may be a boon for those seeking to derail the bill, because it may require the Senate to go back and vote on the legislation again before it can be voted on by the House. Even so, few are counting on the bill’s failure, given the desperation of a GOP that promised billions to billionaires and is now frantically trying to pay the devil his due.

Many of the implications—and intentions—of this bill are all too clear. By creating massive deficits (even the mention of which I am old enough to remember would once-upon-a-time send Republicans into fainting spells), the legislation becomes the precursor to the GOP’s fulfillment of Speaker Paul Ryan’s (R-WI) wet dream: the dismantling of Social Security, Medicare, Medicaid, and other programs on which millions of others depend, often for their very lives.

“The tax bill is one enormous attack on our health,” wrote Nancy Altman and Linda Benesch, respectively the president and communications director of Social Security Works, in the Huffington Post:

It takes away the ability of those with large health care costs to deduct those costs from their taxes. It repeals the part of the Affordable Care Act that seeks to make health insurance affordable. The consequence of that is $185 billion less in health insurance subsidies and $179 billion in Medicaid cuts. All so Republicans can shower huge tax giveaways to their wealthy donors. And those tax giveaways trigger automatic cuts to Medicare.

Medicare covers about 55 million people in the United States, according to the Kaiser Foundation. Right now, 15 percent of the nation’s population relies on it, and the share is growing as baby boomers get older. These are not wealthy people: More than a quarter of Medicare beneficiaries have less than $10,000 in retirement savings. Many are in poor health or have chronic conditions. They spend a large share of their income on out-of-pocket and uncovered costs, which rise dramatically as a share of their resources the older they get.

Seventy million people in this country rely on Medicaid; more than half are people of color. Together with the Children’s Health Insurance Program (CHIP), Medicaid covers nearly 40 percent of U.S. children and almost two-thirds of nursing home residents. The elderly and people with disabilities account for the greatest share of costs, accounting for almost two-thirds of Medicaid costs even though they make up less than a quarter of enrollees. And it’s jointly funded by the federal and state governments through a complex formula that shifts federal aid from wealthier states to historically poor states. Cuts in Medicaid will therefore fall on the poorest and most vulnerable in the states already least willing or able to care for them.

Twenty-two percent of rural residents rely on Medicaid for health coverage, for example, and in states that have Medicaid coverage under the ACA the total is 25 percent. Families USA notes that in rural areas, people are less likely to have higher incomes or jobs that include health insurance, and the population tends to be older with higher incidences of disability. Who are these rural people getting coverage? Children. People of color. Veterans. Low-wage workers. And, Families USA points out, “nearly one-third of those in the population of ‘dual eligibles’—low-income seniors and people with disabilities who rely on both Medicare and Medicaid—live in rural areas.”

These cuts will strike the hardest blows against those who are most vulnerable. People will be left without insurance coverage and without care. They will get sick. They will die. In fact, Harvard economist Larry Summers estimates, conservatively as he notes, that at least 10,000 people will die from the elimination of the ACA mandate alone.

According to conservative estimates, the “tax” bill will produce deficits of over $1.5 trillion over the next ten years. CBO estimates that, because of the PAYGO (or pay-as-you-go) law, which requires that reductions in revenues in one place must be fully offset either by increasing revenues (i.e. taxes) elsewhere or by cuts in mandatory programs, the tax bill will automatically result in cuts to Medicare of $25 billion in the next year and $400 billion in the next decade. “The last time Medicare faced an across the board benefit cut due to the 2013 budget sequester, it literally killed,” wrote Altman and Benesh. “Among other horrors, it led to elderly cancer patients being denied chemotherapy treatment.”

Ryan has famously said he’s wanted to destroy Medicaid since he was “drinking at a keg.” His frat-boy fantasy falls right in line with the objectives of the billionaire Koch brothers, on whom the GOP is largely dependent for its power. As far back as 1980, David Koch spoke about destroying Medicare, Medicaid, and Social Security. And he and his brother have pushed that agenda ever since: Over the last decade, for example, the Kochs have spent hundreds of millions of dollars to create and perpetuate the lie that Social Security is unsustainable. It’s no surprise that with patrons such as these, Ryan, Senate Majority Leader Mitch McConnell (R-KY), and their followers will go to any lengths to throw us all under the bus. And now they may have their last best chance.

That the intention is to use “tax” legislation to gut the social safety net is now no secret. Sen. Marco Rubio (R-FL) admitted as much in an interview just after the Senate vote. And without a scintilla of irony, Sen. Orrin Hatch (R-UT), who advocated for the tax cuts—and hence, the addition of $1 trillion to the national debt—told reporters last week that the United States can’t fund CHIP, which pays for health care for 9 million children and costs about $14 billion a yearbecause “we don’t have any more money.”  

But Hatch is pro-life, so there’s that.

The GOP bill will result in kicking more people off health care. It will, as demonstrated in a graphic analysis by Margo Sanger-Katz of the New York Times result in automatic cuts to a wide range of programs on which people depend. It will undercut education, jobs, infrastructure, environmental safety, services, and all the things for which our taxes help to pay collectively.

Billionaires will have more money. Private jet owners will get a break. Trump can build more empty towers and offset the costs with accelerated depreciation. But to achieve those “goals,” this bill will deliberately make people sicker, less economically productive, and less able to maintain their own well-being. People will die. Children will die.

Still, the GOP sells it as a “driver of economic growth.” And Donald Trump calls it “a big, beautiful Christmas present.” Maybe so—for him, his friends, and his family. But for the rest of the living, breathing people in this country, it’s looking more and more like a dark scene out of a Dickens novel.

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