How bad the American Health Care Act (AHCA), the Republican replacement for the Affordable Care Act (aka, Obamacare), will be for the mentally ill, women, poor people, children, older people, and people needing drug treatment is still unknown. However, everyone expects these groups to receive less financial support in purchasing health insurance and in accessing health care. Meanwhile, the young, healthy and the wealthy have something to smile about if the AHCA becomes law.

But According to Donald Trump, weakening Medicaid and providing skimpier subsidies than Obamacare is just the first step in the rollout of the Republicans' great health care reform plan. For step one of the bill making process, Republicans had to navigate a complicated legislative process called reconciliation, as Paul Ryan likes to remind everyone, including critic, Senator Tom Cotton. So Ryan took this opportunity to do something thoroughly Republican and eliminate the Obamacare-related taxes for the rich and warn the poor that their health care free ride was over.

Don’t Underestimate The Republicans Capacity For Cruelty

After rolling out step one of the American Health Care Act, Republicans in Congress proceeded to make some of the dumbest and most hypocritical remarks in political history. I'm being dramatic but I'm not the only one that attacked Congressman Jason Chaffetz's on Twitter for his dumb iPhone remark, or who was disgusted by Senator Tim Scott's dissing of the Congressional Budget Office (CBO) because he suspects it will reveal the bill as a huge takeaway for the millions who got insurance under Obamacare. And let's just try and forget Paul Ryan's misleading, inaccurate and amateurish PowerPoint presentation where he revealed that he doesn't know the definition of insurance, and his performance on Fox News where he coldly stated that he didn't care about the windfall his bill gives to the rich.

These guys are working hard to get this bill pass, and I don't underestimate their ability to do so.

While you and I are hoping that step one fails to pass the Senate, Ryan seems confident it will not, and he's probably right. All Ryan and his allies have to do is convince enough Republicans that step one was a legislative necessity. The is just the beginning of the awfulness of the Republican health care reform. Step two, on the other hand, may include Republican goodies, like uber generous health savings accounts, the selling of insurance across state lines, poorly funded high-risk pools or anything their cruel hearts can imagine.

Then comes step three of the AHCA, which could include more takeaways and more appeasement of Tea Party and free market conservatives. Who knows what these takeaways will be but it's notable that step one of the AHCA literally begins with two takeaways on abortion funding and Medicaid. Ryan is clearly signaling that he is in solidarity with the cruelest members of his party by addressing these two issues first. Also, I would not be surprised to see a promise to not increase the tax credits for at least ten years in steps two or three of the bill's rollout. I can also see Republicans giving health insurers the green light to sell any plan they want in the individual market at whatever price they choose.

Conclusion

The Republicans have by all measures put forth a cruel and intellectually lazy health care bill. Obama consulted with Jon Gruber and Ezekiel Emanuel, two of the brightest minds in health care finance, ethics, and economics. Ryan worked with the greedy, corrupt Secretary of Health & Human Services, Tom Price, a doctor with no understanding of health care economics. Still, because of the Republican majority in the House and Senate and Trump in the White House (that was hard to write), and the promise of more cruelty for Republicans on the fence, this bill could pass.

(Note: The Republican "Read The Bill," campaign is a joke. The bill is comprised mostly of references to sections of other legislation and the tax code, making it difficult to understand. But, if you want to muddle through it like I did, here it is.)

Tags: American Health Care Act, Paul Ryan, obamacare