Avik Roy finally explains in plain language why he’s really so enthusiastic about the Senate version of Trumpcare:
Repealing and replacing Obamacare does very little to address the fundamental trajectory of the growth of federal involvement in our health care system. To do that, you have to tackle the two big Great Society entitlements: Medicare and Medicaid.
Unfortunately, the Senate is barred from using the reconciliation process to change Medicare. And even if it wasn’t, President Trump has made clear his opposition to Medicare reform. But the Senate bill does historic work to rein in the Medicaid program, putting it on a fiscally sustainable path and reducing its future spending by trillions of dollars.
Most of us think that slashing Medicaid is a bad thing that will devastate the poor, but to Roy it’s the main reason to support the Republican bill.
In fairness, Roy has been sounding the alarm about Medicaid and Medicare pretty much forever, so this is nothing new. But there’s still an odd thing here. The reason to favor Medicaid cuts in the first place is to improve the country’s finances, which the Republican bill doesn’t do. It just hands the money over to the rich. But Roy is enthusiastic anyway. Conversely, he never seemed all that thrilled with Obamacare’s cuts to Medicare, even though they were actually done right: they reined in spending growth by cutting payment levels to doctors and hospitals rather than reducing benefits or tossing people out of the program. The result was a significant boost to the solvency of the Medicare trust fund according to both the CBO and the Medicare trustees.
In any case, even if the rest of the bill is disappointing, kicking 15 million people off Medicaid and saving $772 billion apparently makes the whole thing worth it. Hooray.