After seven long years, the Republican alternative to the Affordable Care Act has finally come lurching across America’s political stage, devised by House Speaker Paul Ryan, Republican of Wisconsin, and backed by an uncomprehending President Trump, who promises something “far less expensive and far better.”

Far better? Ryan’s American Health Care Act is a grotesque, stitched-together, rightwing monster, offering staggering tax breaks for America’s very richest citizens while stripping health-care coverage for tens of millions of Americans in desperate need. The number of Americans lacking health coverage is projected to nearly double to fifty-two million by 2026. At the same time, the plan’s $880 billion in health-care cuts for low and moderate-income Americans would be used to fuel a jet-stream of tax cuts for those at the top.

The Republican health bill would fully incarnate Ryan’s Ayn Rand-inspired vision of government’s proper role:

Those who win:

The American Health Care Act would mark one of the largest upward transfers of income in U.S. history, injecting $600 billion worth of tax cut savings into the accounts of the nation’s wealthiest people. Taxes on the investment income of the nation’s biggest earners, a key part of the ACA revenue stream, will be slashed by $158 billion.

Fully 40 percent of tax savings achieved by ACA cuts would flow to the richest 1 percent, who would enjoy average tax cuts of $37,000. Meanwhile, the lowest wage earners would receive an average tax cut of just $150.

The tidal wave of tax cuts, derived almost directly from cuts in Medicaid coverage, extends to the healthcare industry’s biggest players. Health insurance corporations are in line for $145 billion in reductions. (Executives of these firms will also see their compensation climb, thanks to the removal of controls in the new GOP bill).

Drug corporations, already America’s most profitable sector, are targeted for $25 billion in tax cuts. Medical device corporations will also receive $25 billion in tax savings. But according to Trump budget chief Mick Mulvaney, all Americans should cheer the good fortune of these firms and the fortunate few individuals.“We promised at the outset that we were going to repeal all of the taxes,” he crowed. “Who cares if somebody else benefits?”

Those who lose:

SCROLL TO CONTINUE WITH CONTENT Never Miss a Beat. Get our best delivered to your inbox.







By 2026, Trump’s plan will drive up the number of uninsured Americans by twenty-four million to a total of fifty-two million, the Congressional Budget Office’s stunning new study reports. In the next year alone, the number of people left without health insurance will soar by 14 million because of cutbacks to Medicaid and other ACA funding.

Under the Affordable Care Act, twenty million gained health insurance protection, with the uninsured rate in America falling to 10.9 percent last year from 17.1 percent in 2013. Costs would climb prohibitively for millions of others barely scraping by.

Key ACA provisions included coverage for people with pre-existing conditions. Jeff Jeans, a lifelong Republican, testified at a town hall meeting with Ryan that the ACA literally saved his life, giving him coverage when he was diagnosed with cancer—a preexisting condition that would have made him uninsurable before Obamacare. Under Ryan’s plan, Jeans could lose his coverage forever if he ever lets his insurance lapse. And, as part of an expensive, high-risk pool—one that is no longer subsidized by healthier people who must buy into the system—The Washington Post explains, Jeans could see his premiums skyrocket even as insurers could refuse to cover some of his needs. Ryan dismisses the ACA’s mandate that insurance companies give people like Jeans affordable coverage as an unwarranted intrusion into individual “freedom.”

Ironically, despite all of Trump’s campaign-trail declarations about his enduring commitment to the “forgotten men and women” in struggling working class and rural communities, many of the hardest shots in “Ryancare”—as with new Trump budget provisions—will hit these people the hardest. Older workers in struggling factory towns and rural communities, already facing economic uncertainty and social instability, will have to contend with a new set of rules and costs designed to drive them out of government-assisted insurance.

For example, “The C.B.O. estimates that the price an average sixty-four-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.” The projected outcome: “By 2026, the uninsured rate for those fifty to sixty-four earning less than about $30,000 would more than double, from around 12 percent to around 30 percent.”

Ryan’s own southeastern Wisconsin district has been devastated by the offshoring of jobs to Mexico and China, and thousands of older workers displaced by corporate globalization find themselves in low-wage jobs offering limited health benefits. However, evidently anticipating a hostile reception to his healthcare plan and other policy prescriptions, Ryan has carefully avoided holding any town-hall meetings in his district.

Ryan’s neglect of citizen opinion outrages constituents like Racine resident Ethel Gates, sixty-nine, a retired healthcare worker belonging to the Service Employees International Union: “If you’re going to have enough gall to put out a plan like this, at least you should listen to the people you are hurting.” Ryan’s plan would mean widespread pain across his home base. “You’re not just harming Democrats, you’re hurting everyone.”