The Republican Bid to Kill the ACA Is a Trojan Horse

In his last five years, my grandfather used Medicaid to cover his nursing-home care. He spent those years in a wheelchair and needed professional help for his most basic needs. Thanks to Medicaid, he got that help.

Now House Speaker Paul Ryan and his fellow Republicans want to gut the program, as Ryan revealed in a set of talking points that received shockingly little press coverage.

The changes that House GOP leaders are proposing for our health care are radical -- far more radical than repeal of the Affordable Care Act (ACA) standing alone.

The House GOP plan uses ACA repeal as a Trojan horse for throwing health care for more than 74 million people into chaos. That's the number covered by Medicaid and the Children's Health Insurance Program, including everyone from newborns to the very old.

Will Medicaid Be There for Us?

My grandfather was 89 when he underwent open-heart surgery. He weathered the operation, and as he emerged from the anesthesia was sharp enough to remind my grandmother to make a car insurance payment. A few days later, though, he had a stroke. He never walked again.

My grandmother, as determined as she was, couldn't give him the help he needed. She and my grandfather turned to Medicaid, and he joined the almost two-thirds of the country's nursing home residents the program covers.

They wouldn't have been able afford long-term care without it. My grandfather, a pharmacist, owned a neighborhood business that he and my grandmother, the bookkeeper, struggled to keep afloat. For retirement, they lived on Social Security and some help from my parents. Medicaid was there for them, too.

If Ryan's talking points become law, though, none of us may be able to count on Medicaid being there for us. In the name of "flexibility," Ryan would shred Medicaid's 50-year guarantee: if you're eligible for Medicaid, you can enroll. He'd also eliminate the federal government's commitment to funding the program according to need.

Chaos and Uncertainty

Ryan offers states a no-win, Sophie's choice: take a "block grant" for Medicaid, or a "per-capita allotment." Either way, the GOP will slash funding for this joint federal-state health program and create chaos and uncertainty for all of us.

Appallingly, this dismantling of Medicaid is cloaked in a House Republican proposal to "replace" the ACA with rewards to the hyper-wealthy and worse health care at higher costs to the rest of us. The outline includes tax shelters through "health savings accounts," high-deductible plans, an end to income-based subsidies, and funding for high-risk pools that segregate the old and sick into plans with exorbitant premiums and deductibles.

On top of that, the gutting of Medicaid -- both elimination of the expansion and dismantling of the entire program as we know it -- opens the door for yet another tax break to the rich. As a candidate, Trump's tax proposed cutting $6.2 trillion in federal revenue over 10 years, with the top 0.1 percent getting an average tax break of $1.1 million each.

In all, the health care package outlined by Ryan amounts to nothing less than a redistribution of wealth from the poor and middle-income to the rich.

A You're-on-Your-Own Ideology

The move is unimaginably heartless. As John Cassidy writes in The New Yorker,

In many ways the expansion of Medicaid has been Obamacare's most successful element. As health-care programs go, Medicaid is a cheap option, with relatively low costs and low rates of inflation.

So, why are House Republicans dead-set on starving this program? It's their purely free-market, you're-on-your-own ideology.

When the ACA offered states almost full funding to expand Medicaid, the right was rabidly opposed, insisting the federal government would withdraw support. But they were speaking for themselves, letting us know that, once in power, they would betray our national commitment to our families -- as they're aiming to do now.

Thirty-one states have taken up Medicaid expansion, Louisiana being the latest. When Medicaid was expanded in that state, patients broke into tears of relief. "People have needed coverage here for a long, long time," David Hood, who served as the state's health secretary from 1998-2004, told the Los Angeles Times. "This is long overdue."

The House GOP's assault on Medicaid is an attack on our government's ability to make a real difference in people's lives.

Backtracking on Equality

It's also an attack on efforts to achieve racial equity. One-third of non-elderly African American and Latinx adults use Medicaid. Fewer than one in five white adults do. The refusal of hold-out states to expand Medicaid, has created a new health care Mason-Dixon line.

Despite Republican attacks, Medicaid is popular, especially among those covered by it, and the Medicaid expansion is supported by two-thirds of Trump voters. But the GOP and President Donald Trump, whose approval ratings recently plummeted to 38 percent, don't want those solutions.

If their plan goes through, we'll have to prepare to care for our aging parents at home without the skills or time to do it properly. To funnel more dollars to the rich, House Republicans will deny tens of millions of families the security that Medicaid provided my grandparents in their final years.

You're on your own, is their message.

But you aren't on your own. Millions of us nationwide are clamoring for quality, affordable health care for all. Tell your lawmakers you believe in a country that cares for each of us. Tell them you will fight for that country as if our lives depended on it.