Mitch McConnell’s epic bamboozling failed to persuade a sufficient number of his Republican colleagues, so the Senate vote on his bill to repeal Obamacare, decimate Medicaid, and cut taxes on the rich has been put on hold. The final stake, however, has not yet been driven through its cankered heart.
Both the House and Senate versions of the ACA repeal are almost without precedent in American history. By taking away health coverage from more than 20 million Americans, these bills tread new ground: The withdrawal of life-saving services from tens of millions of citizens is something that no previous Congress has ever seriously considered. The closest analogy I can come up with is the Fugitive Slave Act, passed in 1850, which required Northern states to help Southern ones seize free African Americans in the North so they could be returned to slavery down South.
It’s possible, of course, that McConnell, Paul Ryan, and their GOP colleagues don’t believe the Congressional Budget Office’s projections. Perhaps they really are convinced that the massive tax reductions their bills would bestow on the rich would lead to so much new investment and so many new jobs that tens of millions of Americans would see their incomes rise to the point that they could bid Medicaid goodbye and purchase health coverage on their own. Indeed, the GOP legislators who support these bills would be monstrously cruel if they didn’t hold those beliefs.
But if that’s indeed what they believe, they should be willing to accept some consequences should those beliefs be proven false. If, as the CBO projects, 21 million or 22 million or 23 million (or even just five or ten million) Americans lose their health coverage should any version of these bills pass, simply saying, “Whoops!” won’t really qualify as a form of atonement.
So here’s a modest proposal: If, one year after such a bill is signed into law, the number of uninsured Americans rises, the representatives and senators who voted for that bill should be required to go without health care. No need to be draconian about this: Let’s say the number has to decline by a full tenth of the CBO’s highest estimate, so that at least 2.3 million more Americans have to join the ranks of the uninsured before this penalty kicks in. Beginning 18 months after enactment, so long as the number of uninsured remains higher than what the CBO projected that number would be if the ACA had stayed in place, the penalty on those senators and representatives would stay in place, too, whether or not they remain in office.
Now, it’s not really sufficient that these representatives and senators merely lose their health coverage. Many can get coverage through their spouses, or simply pay their bills out of pocket. Such is not the case, of course, for Medicaid recipients: When they lose coverage, their only recourse is to go to emergency rooms or free clinics. The fair solution would be to restrict those representatives and senators to getting their health-care needs met in the same ERs and clinics that Americans without insurance must go to when they get sick or injured.
Enforcing such a provision might be tricky. The only solution I can come up with is to make it a felony, punishable by, oh say, five years in prison, for these representatives and senators to receive treatment anywhere but ERs and free clinics (well, let’s say from paramedics, too), and to make it a felony, punishable by 30 to 180 days in prison, for medical personnel outside those ERs, clinics, and ambulances to treat those representatives and senators. Should those representatives and senators try to pass themselves off as somebody else, their term of incarceration should be increased by 18 to 24 months.
I can think of no reason why the senators and representatives who support this legislation should oppose these amendments. After all, either they sincerely believe that, through the magic of tax cuts on the rich trickling down to everyone else, the number of uninsured Americans won’t rise, or else they are moral monsters, which we all know they’re not. By backing such a provision, they’d merely be demonstrating their good faith and attesting to their rudimentary morality.
Mitch, Paul—how about it?