As someone who supports available and affordable health care I admit that I am greatly enjoying the civil war among Republicans who are twisting themselves into knots as they try to repeal the Affordable Care Act (ACA). Seven years of talk have been exposed as nothing but talk. Seven years of congressional votes to repeal Obamacare have led to nothing. Sad!

With fearless leader holding the reins in the White House everything was supposed to be easy. But the mashup that is taking place concerning national health care policy has demonstrated that, like on other issues highlighted in his campaign for the presidency, there is no there, there.

Incapable for various reasons of coming up with the administration’s own version of repeal-and-replace, Trump has kind of, sort of latched on to the legislation put forth by House Speaker Paul Ryan. Ryan’s bill really is Obamacare lite or Obamacare 2.0. The legislation tries to keep things from the original legislation that even Republicans recognize as good, except that their bill’s nuances would make such issues unaffordable and moot. Stripped down to the essentials, the House bill is basically the opposite of something that Robin Hood, were he a member of the House, would have proposed. The Republicans want to rob from the poor to give to the rich.

The Republican bill would legislate a very simple proposition: I’ve got mine; good luck getting yours. They think that just because someone has access to purchasing something (everyone has access to purchasing a mansion in Palm Beach), the free market will take care of everything. Except that if you are struggling to pay the rent and put food on the table for your family, “access” means nothing. A token tax credit, no matter what the form, is not going to make health care “accessible.” People will gamble on their and their families’ physical and financial health simply for lack of any other viable option.

The Congressional Budget Office (CBO) analysis of the Trump-Ryan plan laid out the potential consequences of the bill, highlighted by the projection that 14 million Americans would lose their health coverage next year, and another 10 million would fall out in the next nine years. A leaked White House analysis put the situation in a worse light, indicating that 26 million people would lose coverage in the next 10 years. So much for the Trump lie that “everyone” would continue to have their coverage.

The good news, according to Trump, Pence, Ryan and McConnell et al is that the wealthiest Americans would save billions of tax dollars over the next ten years. This would undoubtedly lead to the re-investment in businesses that will create millions of good paying jobs that will allow formerly unemployed or poorly paid individuals to afford the ever-increasing costs of an unregulated health care industry. This is going to be so great!

The reality, of course, would be much harsher.   Some of the things included in the House-proposed, Trump-endorsed version of health care include these “great” procedures:

• Higher deductibles, which make insurance policies not much more than “stop-loss” coverage on major medical matters, providing no assistance for day-to-day medical needs
• Higher premiums for all, without ACA subsidies
• Particularly higher premiums for older Americans who might be out of work or retired, but not yet eligible for Medicare (The American Association of Retired Persons, AARP, opposes the bill)
• Tax credits that would not come close to allowing those most in need to purchase health insurance
• A reduction in benefits that would be guaranteed in law
• The re-introduction of the famous “donut hole” of prescription drug coverage, where Medicare participants often had to pay for a substantial part of the costs of their medications

And it goes on. The Trumpcare bill would begin the phase out of Medicaid expansion funding to the states that opted in, starting in 2020. But stay tuned on that. To appease the far-right wing of the Republican Party, the White House and the House of Representatives are considering moving the phase-out start to 2018 – which, the thinking goes, will then turn off the not-quite-as-far-right-wing of the party. Eleven million people are getting their coverage through this program.

In its place Trump-Ryan is looking to provide Medicaid funding for the states that is capped based on the number of people covered. This will collectively over a period of years reduce federal Medicaid payments to the states by billions of dollars.

The net effect of a fully implemented Trumpcare program would be substantial. Higher deductibles, higher premiums, less premium support based on income and reduced Medicaid funding will lead to many people being unable to “access” health care that they can afford. People losing health care will get sick and die. People losing health care will go bankrupt. All for the sake of trying to implement a far-right political philosophy that cares nothing about people whose resources are small and whose need is great.

“Death panels”

Much was written in 2009 and 2010 about how care to people under the ACA would be rationed on the basis of decisions by some appointed panel. Sarah Palin railed against the supposed “death panels.” That did not happen.

But with Trumpcare we already have had three “death panels” of a sort in operation. They go by the names of the House Ways and Means Committee; the House Energy and Commerce Committee; and the House Budget Committee. All three committees have voted approval of Paul Ryan’s proposed Trumpcare program. Chris Collins, congressional cheerleader-in-chief for Trump is a member of the Energy and Commerce Committee. People will get sick, die and go bankrupt because of the work of these committees.

Paul Ryan, who a couple weeks ago basically said, take it or leave it, is now saying that the House will “incorporate feedback” from House Republicans to make changes to what was originally laid on the table. He also talks about the three phases of Trumpcare, namely: partial repeal by legislation; stripping enforcement regulations by the Department of Health and Human Services; and then legislation prepared in a bi-partisan way to finish the job of implementing Trumpcare. Even Ted Cruz says that phase three of the plan will never happen.

If Trump and his Republican Congress succeed in approving Trumpcare in its current form or some other similar variation, there could be some additional “death panels” of a sort coming up next year or in 2020.

The proposed Trumpcare legislation will, in one form or another, reduce Medicaid payments to the states. The majority of the Medicaid funds expended by the states go for the care of seniors in nursing facilities or in other forms.

With reduced Medicaid funding coming from Washington, governors and state legislators will be faced with the choice of: (1) having to limit Medicaid funding to either seniors or to the poor who rely on Medicaid for their health care needs; or (2) raising taxes or cutting other programs to provide necessary funds for Medicaid.

Asked on MSNBC this week about this Medicaid dilemma in his upstate New York district, Congressman Chris Collins suggested that the state would raise taxes to cover the expense of maintaining current Medicaid funding. Great job passing the buck Chris, but of course you have learned from the master in the White House about such techniques.

There seem to be enough problems among Republicans in Congress to possibly prevent any of this from happening. Trump himself, claiming to be supportive, is not publicly engaged in the issue because he knows that his base will get clobbered by this legislation. He held two campaign rallies this week, not mentioning health care at all at one and only in passing at the other.

The Hill had a story yesterday about some senators hoping that the legislation fails in the House so that the senators won’t need to deal with it. Some, such as Ted Cruz, Rand Paul and Mike Lee, are actively fighting Ryan’s plan – to make it even more of a right-wing document.

Trump has said ”nobody knew how complicated health care was.”  Well, everyone who knew anything about health care did know that.  Trump’s quote epitomizes the equation describing him: Ignorance + Arrogance = Incompetence.

The Republican Party of Donald Trump and Paul Ryan was put in place to repeal Obamacare. If they fail to do so, which seems more likely with every passing day, all other Trump political and legislative initiatives will get that much harder to approve. The gang that can’t shot straight, headed by the reality TV personality, is coming face-to-face with reality. Not sad! Good!