Nobamacare

Don't count on conservative "opponents" to torpedo the Ryan plan for ending Obamacare.  The Freedom Caucus is making noise, but at the heart of the current proposal is a goal dear to the far right: the destruction of Medicaid.

Most Americans who have health insurance enjoy it as an employee benefit, and are entirely indifferent to the cost of purchasing their own.  Nevertheless, the insurance exchanges got most of the attention in debates over the ACA — even though it was the law's expansion of Medicaid that was most significant in bringing health care to millions who lacked it.  The Republican "Patient's Choice Act" will not merely eliminate Medicaid for those enrolled in the expansion, but create a system of block grants to the states that will destroy the program entirely.

The single most important goal of the Obamacare repeal, like virtually every other piece of Republican legislation since Reagan, is to cut taxes on the rich.  Finding the money to do that inevitably involves reducing benefits for everybody else.  Ending Medicaid — which pays for half the babies born in the United States and half the elderly in nursing homes — uses a lot of money that otherwise might be lining rich people's pockets.  Sad.

The Patient's "Choice" Act will give poor patients a "choice" between medicine and food.  The chief hope for its failure is defections by Republican senators from states where Medicaid was expanded under the ACA, and where its elimination may do some real political damage.  Those senators now are working hard to figure out just how much damage might be done, and how well that damage might be offset by the gratitude of wealthy donors.