Their dirty little secret is officially out.

The Senate’s “Better Care Reconciliation Act,” which was finally released to the public on Thursday morning, doesn’t provide better care for anyone. Instead, it guarantees things will get worse for the poor, the elderly, and the disabled.

The bill’s main mission is to reduce federal spending on Medicaid. To borrow an adjective from President Trump: That’s mean. That government health care program currently covers 74 million Americans, including children, senior citizens in nursing homes, and people of all ages with disabilities. The Senate’s Medicaid reduction plan is cast as a “phase-out,” but don’t be fooled by that euphemism. It stands for slowly but surely reducing the pool of people who qualify for coverage and the federal money available to cover their medical costs.


The bill sets up a new system of federal tax credits to help people purchase health insurance. But available plans would cover fewer medical services and, to qualify, people would have to earn less than they have to now under the Affordable Care Act. As federal funding trickles away, individual states would also have to decide how much they want to throw in to cover the gap. In other business considered essential by Republican leaders, the bill also repeals the individual mandate requiring people to buy coverage, as well as the mandate requiring employers to provide it. It eliminates virtually all taxes required under the ACA, and with that, eliminates much of the ACA’s funding.

After crafting the bill behind closed doors, without a single public hearing, Senate majority leader Mitch McConnell now wants to hold a vote before lawmakers go home for the July Fourth holiday recess. With Democrats committed to opposing it, McConnell needs 50 of 52 Senate Republican votes to pass this bill. Shortly after its release, four Republican senators issued a statement saying they are not ready to vote for it. Senators Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah, and Rand Paul of Kentucky said the bill doesn’t go far enough to deliver on the GOP promise to repeal the ACA and lower health care costs. In other words, it’s not mean enough for these lawmakers. Meanwhile, Senator Susan Collins of Maine, a key moderate, was noncommittal but said she had “a number of concerns” about the bill. Even Trump avoided a ringing endorsement, saying the legislation would be subject to “a little negotiation.”


Beyond the obsessive zeal of Republicans to dismantle the ACA and, with it, President Obama’s key accomplishment, let’s be honest about what’s going on here. This is about the powerful and the wealthy deciding that when it comes to health care, they have limited responsibility for the powerless and the poor. The dirtiest little secret is that proponents of the Senate bill are betting that we, as a society, feel the same way — that Americans, collectively, are as mean as they are.