Tom MacArthur. Photo: Dominick Reuter/AFP/Getty Images

Earlier this year, the House GOP wrote a bill that would have thrown 14 million people off of their health insurance next year, and increased the ranks of the uninsured by 24 million within a decade. The legislation would have accomplished this by cutting $880 billion from Medicaid; radically increasing the cost of health insurance for older people; and drastically reducing the size of health-care tax credits for the middle class.

In exchange for this austerity, the bill would have delivered a large tax cut for the rich; lower premiums in the long term, because fewer old, sick people would be able to afford insurance; and $3 billion in savings for the Social Security Administration, because fewer Americans would live long enough to enjoy their retirements.

The Congressional Budget Office detailed all these effects, in a report released March 14. Ten days later, Paul Ryan pulled the bill from the House floor without a vote, as a large swath of the Republican caucus deemed the it unacceptable.

Shortly thereafter, Mark Meadows, chair of the far-right House Freedom Caucus, and Tom MacArthur, a self-styled moderate Republican, began discussing how the GOP could fix all that was wrong with Trumpcare.

After weeks of deliberation, they found an answer: Add a provision allowing insurers to discriminate against people with preexisting conditions and drastically raise premiums for all who require mental-health and maternity coverage, in any state that gives them permission to do so.



To ensure that no one with a preexisting condition would lose access to health care in such a state, the provision included funding for high-risk pools — except, this funding was so meager that every health-care economist, policy expert, or person who bothered to perform a Google search on the subject, knew that it would ensure no such thing.

They left the rest of the bill virtually unchanged. And then, they passed it through the House.

On Wednesday, the CBO released its score of the new bill. The budget office found that the legislation would throw 14 million people off of their health insurance next year, and increase the ranks of the uninsured by (only) 23 million within a decade.

It also found that in states that took advantage of the MacArthur and Meadows’s provision:

Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums. As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs. That instability would cause some people who would have been insured in the nongroup market under current law to be uninsured …[O]ut-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services.

Hours after this report was released, the conservative news outlet Independent Journal Review asked Meadows for his reaction. The account of his response is worth quoting at length:

Freedom Caucus Chairman Mark Meadows (R-N.C.), — who played a pivotal role in including state waiver options in AHCA — hadn’t read the full report yet, but initially said he saw it as “good news.”



When reporters pointed out the portion of the CBO report saying individuals with preexisting conditions in waiver states would be charged higher premiums and could even be priced out of the insurance market — destabilizing markets in those states — under AHCA, Meadows seemed surprised.



“Well, that’s not what I read,” Meadows said, putting on his reading glasses and peering at the paragraph on the phone of a nearby reporter…After reading the paragraph, Meadows told reporters he would go through the CBO analysis more thoroughly and run the numbers, adding he would work to make sure the high-risk pools are properly funded.



Meadows, suddenly emotional, choked back tears and said, “Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

Of course, Meadows doesn’t need to make that “political decision” today, because he already did, three weeks ago.

The congressman continued:

“In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.”

Meadows’s remarks bring to mind one of the Trump era’s defining questions: Are these people really this stupid, or evil, or both?

Let’s take Meadows at his word: He would never want to make a “political decision” that undermines someone else’s access to health care, and had no idea that the bill he wrote would do that.

When the first CBO report revealed that Trumpcare would leave 24 million more people uninsured, Meadows just assumed that this was the number of healthy, devil-may-care Americans who would be freed from the burden of the individual mandate. When he pushed for even more draconian cuts to Medicaid than those included in the bill, he did not realize that poor people can also die from breast cancer, and then be mourned by brothers who loved them. And when he demanded measures to weaken regulatory protections for those with preexisting conditions, he did not bother to research how much it would cost to finance stable, high-risk pools — and ignored the many, many news reports that warned the amount he was allocating was insufficient.

Finally, when the CBO released its report on the effects of the provision he co-authored, he read its findings so carelessly, he thought that they constituted “good news.”

If Meadows was honestly representing his views about health-care policy to IJR, than he is far too negligent, incompetent, and intellectually impaired to hold public office.

If was lying about his views — and invoked his sister’s death from breast cancer as a means of distracting from his mendacity — then he is far too morally monstrous to hold a congressional seat.

Tom MacArthur’s response to IJR’s questions about the CBO’s findings was no less stunning:

Rep. Tom MacArthur (R-N.J.), who was a primary negotiator in getting AHCA through the House, also downplayed the CBO score, noting that CBO personnel are “not prophets.”



“They’re trying to answer questions that I think it would be better where they say ‘I don’t know,’” MacArthur said.

Here, the congressman suggests that the only honest answer to the question of whether his health-care bill will condemn nonaffluent cancer patients to preventable deaths is “I don’t know.”

What a comfort that must be to every American who worries about the cost of chemotherapy; what a relief for “somebody’s sister or father.”