An Ignominious Bill Passed By an Inglorious Body
Millions will lose health insurance, but at least all those struggling Americans in the top 1 percent will get a big tax break.
Senate Votes to Comfort the Comfortable and Afflict the Afflicted
THE LEGISLATION SENATE REPUBLICANS passed on Tuesday is probably going to kill a lot of people.
It sounds stark when you put it that way, but death is a stark thing. It’s also what can be reasonably expected from the GOP legislation, especially the cuts to Medicaid and the Affordable Care Act projected to leave nearly 12 million Americans newly uninsured.
When people can’t pay for medical care they frequently don’t get it. And when people don’t get medical care, they’re more likely to die early from a preventable condition. That’s what you’ll find if you read the latest research, and what you’ll learn if you ask people working on the front lines of medical care.
And death doesn’t even capture the full impact of the bill, which thanks to Tuesday’s vote seems likely to become law.
That outcome is not yet a foregone conclusion, to be clear. The bill requires approval from the House, where a different version passed in May and where several Republicans have already said they object to the Senate’s iteration.
But while those Republicans have enough leverage to block approval, forcing some kind of negotiation between the houses, they are already under enormous pressure from party leaders—and, especially, from President Donald Trump, who has said he wants a bill on his desk by July 4.
That deadline is arbitrary, and for Trump the primary motivation may be his hopes of staging a signing ceremony amid Independence Day pomp. But so far it appears to have succeeded in moving the debate along at a speed that is downright astonishing—and alarming—for such consequential legislation.
House Republicans held a vote five days after unveiling statutory language, putting the proposal through only perfunctory committee markups. Senate leaders did that one better, dispensing with even the charade of normal procedure and bringing their bill to the floor, where they were literally adjusting language on paper just minutes before the final vote.
Politically, it was a savvy strategy for avoiding scrutiny. So was packaging the entirety of the Trump domestic agenda into one legislative package, making it difficult for opponents to focus—and rally supporters around—any one part.1
As of a few days ago, nearly half of America hadn’t heard anything about the “Big Beautiful Bill,” according to Democratic polling from Priorities USA. And only 8 percent had heard it included Medicaid cuts.
Mission accomplished, you might say.
But in trying so hard to shield the bill’s true nature from the public, Republican leaders may have also succeeded in hiding parts from their own members, who might not appreciate just how much some features of the bill undercut supposedly cherished MAGA goals like lowering the cost of living and making U.S. industry more competitive.
And that’s to say nothing about the disproportionate effects some elements of the bill will have on their own constituents.
YOU CAN SEE IT CLEARLY in the provisions yanking away Biden-era subsidies for clean energy and electric vehicles, in many cases quickly. (The tax credit for consumers buying electric vehicles would end in September.) It’s a way to own the libs, now that Trump has turned clean energy into almost as much a bogeyman as trans athletes and woke professors.
But Biden’s subsidies unleashed a factory-building boom that the legislation will weaken and maybe kill, which is why the bluest of blue-collar unions—electrical workers, building trades, iron workers—spent the last few days blasting the bill as a historic “job killer.” And those jobs are likely to have an outsized effect on red states like Texas, now America’s capital for solar-panel manufacturing, because that’s where a disproportionate share of the subsidies went.
And that’s just the immediate effect. Giving up support for wind and solar means giving up on the easiest, cheapest way to increase generating capacity right now—something tech executives desperately tried to convey to Trump and his allies, with a warning that it will set back U.S. firms in their quest to develop artificial intelligence. That’s on top of ceding industries like battery storage and electric vehicles to competitors, especially the one Trump brings up the most: China.
Look down the road and you’ll see an America that is more reliant on other countries for energy—and, most likely, paying a lot more than it would if it had spent the next few years keeping up in the global alternative-energy race. Americans can expect an extra $170 billion in annual energy bills between now and 2034, according to a projection by the firm Energy Innovation.
THE BILL’S FOOD-ASSISTANCE provisions work out to a roughly 20 percent reduction, in what would be the largest cut in the history of what’s now known as the Supplemental Nutrition Assistance Program (SNAP, still widely called “food stamps”). The biggest part of the cut involves a shift in costs to the states, which for the first time in the program’s six decades would have to cover a share of the costs. Some states would, as their governors have made clear, drop their programs altogether.
Roughly 40 million Americans rely on SNAP at any one time—many of them children or senior citizens or people with disabilities, most of them very poor. Projections suggest they’d all feel the effects, because the bill would gradually reduce how much assistance beneficiaries get. A few million would lose benefits altogether.
And then there are those health care cuts, which include not only new “work requirements” but a bunch of other cuts as well—some directly reducing benefits, like an adjustment to a formula that will allow insurers to get away with providing skimpier coverage to Obamacare customers, others miring beneficiaries in so much paperwork that they are bound to lose coverage in a maze of new government bureaucracy.
The effects of the health care cuts will ripple through communities, because even if you don’t rely on Medicaid or Obamacare you may rely on hospitals that lean heavily on those programs for funding. That’s especially true in rural areas, where providers struggle a lot more to make the economics work—and could respond to cuts by shuttering services or closing altogether.
But the effects will be most severe on those individual beneficiaries who lose coverage, as many studies have now shown.2 That includes a groundbreaking paper drawing from census and tax records suggesting Obamacare’s expansion of Medicaid, which the GOP bill targets, saved lives by the thousands. A newer study by three physicians that ran in the Annals of Internal Medicine suggests the same thing.
TRUMP AND HIS ALLIES understand how politically dangerous these cuts to food assistance and health care programs are. That is why they’ve tried so hard to downplay and deny the likely effects—insisting over and over again that Republicans were merely trying to protect the vulnerable, the people who in their view truly deserve help, and that they are targeting only waste, fraud, and abuse.
Some of the programs Republicans are targeting really do have some waste, fraud, and abuse, the kind you’ll find in any large public program—and in the private sector, too. But there are ways to cut down on fraud and abuse that focus on the perpetrators (e.g., agents and brokers selling coverage under false pretenses, medical providers cheating on billing codes to charge) rather than beneficiaries.
Trump and the Republicans opted not to take that approach, just as they opted against cutting what amounts to corporate welfare for insurance companies in the Medicare Advantage program, the private alternative to traditional Medicare. Still more telling, though, they aren’t plowing even a portion of these cuts back into these programs or others that serve the poor.
After all, Trump and his allies could have put a few hundred billion dollars into some other kinds of assistance, like housing or child care. Or they could have put some of the dollars back into health care, by increasing funding for clinics that provide charity care (a cause Republicans have traditionally championed) or subsidizing the salaries for nurses, home health aides, and other direct care workers, in order to address widespread shortages that have seniors and people with disabilities on long waiting lists for assistance.
But that’s not what they chose to do. Instead, Republicans are shoveling that money into tax cuts, and in a way that overwhelmingly benefits the wealthy, making this legislation arguably the biggest transfer of money from poor to rich in American history.3
That decision might reflect a considered judgment Trump and his allies have made about policy, based on principled beliefs about the virtues—and long-term benefits—of downsizing government in order to finance these kinds of tax cuts.4 But the legislation could also be a sign that this bill’s supporters care a lot about making life easy for the most well-off Americans, no matter what it does to the lives of the least fortunate.
Including the extension of the 2017 tax cuts—the rare cause that unites pretty much all Republicans—also helped, as it gave everybody in the conference a reason to vote yes.
Supporters of the bill say there’s no solid evidence that Medicaid or ACA coverage reduces mortality, and rely heavily on a single study to make their case. I explained a few weeks ago why the one major study Republicans like to cite in their defense—though solid and important—doesn’t really disprove mortality effects, and why most scholars think a series of more recent studies suggest overwhelmingly that the mortality effect is real.
Just to put some numbers on this, the Budget Lab at Yale estimated this week that “changes to taxes and Medicaid and SNAP spending proposed by the Senate budget reconciliation bill would result in a decline of 2.9 percent (about $700) in income for the bottom quintile, but an increase of 1.9 percent (about $30,000) for the top 1 percent.”
I haven’t mentioned the possibility that supporters of this bill care about the deficit, and that was deliberate. Taking that possibility seriously makes no sense when the bill as a whole will add trillions to the national debt.
Best subtitle ever “Senate Votes to Comfort the Comfortable and Afflict the Afflicted”
Well, we are all gonna die. The GOP (gross old party) just wants to speed things along.
They are setting us up for Medicare for All with their voodoo accounting. They won’t be in power forever and at least a few of us will outlive them.
To say nothing of what this does for Ice. Anyone outraged by what's been happening with masked, abusive, unidentified secret police had better buckle in, things are about to get a hundredfold worse.