With the bill 51 votes away from law, the central philosophy of the Trump era is one step closer to becoming policy.
Stop me if you’ve heard this one. A Trump voter in Trump country—maybe a coal miner in West Virginia or the patron of a sleepy diner in rural Kentucky—is a recipient of Medicaid coverage under Obamacare for a life-threatening illness or chronic condition, but still maintains total support for President Trump and a zeal for repealing the program.
One good answer might come from a recent interview on the AHCA between Alabama’s Representative Mo Brooks and CNN’s Jake Tapper. “[The plan] will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool,” Brooks claimed. “That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people—who’ve done things the right way—that are seeing their costs skyrocketing.”
That interview was such a stunner because it’s exactly what Republicans aren’t supposed to say about their health-care bill. Most Republicans paint their support for the AHCA in terms of the deficiencies of Obamacare, the problems low-income people face obtaining affordable health-care, or a perceived inability of the country to pay for the broad benefits of the program.
When pressed, despite the evidence otherwise, party leaders like Speaker Paul Ryan break out PowerPoint to argue that their plan will actually help low-income people and people with pre-existing conditions. Even provisions that are obviously more rooted in a moral background, like support for work requirements in Medicaid, are painted as pieces that will make the whole law better and benefit the lives of everyone involved.
But while Brooks’s comments stray from Republican talking points, they may help explain both the internal logic of the American Health Care Act and one of the main elements to the political appeal of Trumpism.
The AHCA, even by conservative think-tank calculations, will leave many low-income and sick people without insurance they can afford, and does so even as it makes health-care work better for healthy people. Brooks’s explanation, and his close association of morality and health, with the idea that “good lives” produce good health, is just a recasting of the prosperity gospel.
What’s a religious philosophy mostly pioneered by wealthy televangelists and megachurches got to do with pre-existing conditions and Medicaid reform?
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