Tag Archives: Affordable Care Act

Something Encouraging For a Change

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In today’s news, Senator Turtle Face (formally known as Addison Mitchell McConnell, Jr., Republican of Kentucky) delayed the vote on the “Less Money for Health Insurance Equals More Money for Rich People” bill. Presumably, he didn’t have enough Yes votes to pass legislation that nobody (except him and a few rich people?) likes.

This will either give the Republicans a few days to find the necessary Yes votes, or it will give opponents of the bill (of which there are many) the chance to create more No votes. Since the Senate Majority Leader had planned a quick vote on a bill he tried to keep as secret as possible, the postponement appears on balance to be a welcome development.

Proving again that he is indeed the Master Negotiator, the President put on a show at the White House today with Republican Senators, at which he announced:

This will be great if we get it done. And if we don’t get it done, it’s just going to be something that we’re not going to like, and that’s OK, and I understand that very well.

As far as we know, the President has not yet demonstrated in a single case whatsoever that he has any understanding at all of the the American healthcare system, the Affordable Care Act, or the Republican effort to repeal or replace it. Clearly, he is a Big Picture guy.

Consistent with the possibility that this is not Hell, some observers think the Republicans’ struggles are a sign of better things to come. Paul Waldman of The Washington Post writes:

The Republican health-care bill is not dead yet, but it’s in rough shape. Whether it passes or not, it has been an utter debacle for the GOP, making the Affordable Care Act they’re trying to undo more popular than ever, energizing the Democratic base, complicating the relationship between President [DT] and Congress and sowing justified distrust of Republican motives among the broader public.

It has also done something else: moved the debate on health care in America to the left and made single payer much more likely.

Even if the Senate bill fails, Republicans give up and move on to tax reform, and the status quo remains in place, this debate will have had profound effects on our politics. While the Democratic Party may have been moving to the left on health care anyway, its momentum in that direction may now be unstoppable. And the entire country will be more receptive than ever to the arguments Democrats will make. This, by the way, will also be the case if the GOP repeal effort succeeds, because it will make so much that people hate about our health-care system a lot worse.

Let me point to one politician as an illustration. For years, Sen. Elizabeth Warren’s position on single payer has essentially been “Maybe someday” — not opposed to it, but focused in the short term on the more urgent priority of defending and enhancing the ACA. But in an article in today’s Wall Street Journal, we learn that she is now ready to take that plunge:

“President Obama tried to move us forward with health-care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts,” she said during an interview in her Senate office last week. “Now it’s time for the next step. And the next step is single payer.”

Warren is not going to be the last Democrat to take this step. In fact, any Democrat who runs for president in 2020 — and there will be a lot of them — will have a hard time explaining to the primary electorate why they don’t want single payer, and most or all of them will probably say they do.

We can make an analogy with what happened in the GOP after the failure of comprehensive immigration reform [in 2013]…. The situations aren’t exactly the same, but … a dramatic political failure — whether it’s yours or the other party’s — can have profound effects on the choices politicians make about how to approach the electorate. And it’s important to understand that while there are some Democratic politicians who emphatically favor single payer and would be unsatisfied with anything less, most of them would be willing to advocate for a range of policy options, depending on what looks politically achievable and what their base demands at a particular moment.

All the ups and downs of the past eight years, from the beginning of the debate on the ACA to the end of the debate on Republican repeal plans, hold many lessons for Democrats who are still eager to address the problems in the American health-care system. Among other things, we know that voters are risk-averse, that they’re extremely sensitive to out-of-pocket costs, that they want security and that arguments about the glories of the free market aren’t going to be persuasive to them. After seeing how desperately unpopular this Republican plan is, Democrats are going to be much less afraid to defend government health care and advocate its expansion.

And they know that whatever they propose next has to be simple and understandable. We can debate whether the ACA had to be as complex as it was, but next time around, no Democrat is going to believe that you can take on President Trump with a technocratic approach to health care. Saying “Here are the 10 tweaks I’d make to the ACA” isn’t going to cut it.

That isn’t to say that whatever plans they propose won’t be fully fleshed out under the hood, but they’ll have to be presented in a way that is easy for voters to understand. And, yes, Republicans will cry about “Washington bureaucrats making decisions for you,” but Democrats are less likely to be intimidated. Ask your parents or grandparents on Medicare how they feel about their coverage — Medicare is the most popular health insurance program we have, and it’s run by Washington bureaucrats.

It’s important to keep in mind that “single payer” isn’t one thing — if you look around the world at highly developed countries, there is a spectrum of health systems with various levels of public and private involvement. But what they have in common is that they achieve universal coverage while working better and costing less than ours. We could well have 15 Democratic presidential candidates proposing 15 different kinds of single payer. Some may be highly socialized systems — what Bernie Sanders would likely advocate if he runs again — but the ones that are most appealing could be hybrid systems of the kind that have been successful in countries such as France. The way it works is that there’s a government plan that covers everyone’s basic needs, but you can also buy supplemental private insurance to get as many more benefits as you want.

Among the advantages of a hybrid system is that one can actually see a path from where we are now to there. That path runs through Medicaid, which now covers nearly 75 million Americans. What if we auto-enrolled everyone under 65 in Medicaid — it’s there if you need it, but if you have different insurance you’d prefer, go ahead and use that instead. No one would be without coverage. Private insurance would evolve into something you buy to fill in the gaps and get perks that Medicaid wouldn’t provide. Instead of covering all your health care, employers could provide the supplemental private insurance.

As a political matter, you could sell this as something that we could transition to over an extended period, and as a system that satisfies the goals of both liberals and conservatives. Liberals get the universal coverage and security they want, and conservatives get the freedom they want — if you’re rich enough to buy a supplemental plan that includes deliveries of Dom Perignon during any hospitalization, go right ahead.

That isn’t to say that Republicans wouldn’t resist and there won’t be more intense arguments about health care, because they would and there will be. But by handling this debate so terribly and proposing something so monstrous, Republicans have opened up the space for Democrats to go much further than they’ve been willing to before. It’s not impossible to foresee Democrats winning the House in 2018, then taking the presidency and the Senate in 2020 — and then taking the first steps toward making single-payer health care in America a reality. 

End quote.

Bad News, Good News, No News

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I was going to write more about consciousness, in particular about dreaming, but Senate Republicans finally let the rest of us see the healthcare bill they plan to vote on next week. Unless three of them vote No, it will almost certainly be approved by the Republican majority in the House of Representatives. It will then be signed into law by the con man in the White House.

The bill would reduce government spending on health insurance by billions of dollars, which would lead to a harder life or a quicker death for millions of Americans. Most importantly its authors, however, the bill would give a big tax cut to the wealthiest 2% of the population and to favored corporations. Basically, the government will make health insurance more expensive or hard to get for lots of us in order for a few of us to be richer than they already are. You really need to be a Republican to appreciate the beauty of it.

Senator Chris Murphy (Democrat of Connecticut), who seems to be a nice, reasonable person, gives a helpful overview of the Senate bill in this brief video.

In other bad news: 

Except it’s not really news at all. It’s a blog post from Heather Digby Parton (“Digby”) entitled “Why Are They Doing This? Because They Can, or: How To Get Away With Murder”. It summarizes the present crisis and begins with a quote from another writer:

Jamelle Bouie answers the question as to why the Republicans are going forward with their Kill People for Tax Cuts bill [the AHCA] despite the fact that it’s the most unpopular piece of legislation in history:

“The 2018 House map still favors Republicans, and the party is defending far fewer Senate seats than Democrats. Aggressively gerrymandered districts provide another layer of defense, as does voter suppression, and the avalanche of spending from outside groups. Americans might be hurt and outraged by the effects of the AHCA, but those barriers blunt the electoral impact.”

“The grounds for political combat seem to have changed as well. If recent special elections are any indication—where GOP candidates refused to comment on signature GOP policies—extreme polarization means Republicans can mobilize supporters without being forced to talk about or account for their actual actions. Identity, for many voters, matters more than their pocketbooks. Republicans simply need to signal their disdain—even hatred—for their opponents, political or otherwise. Why worry about the consequences of your policies when you can preclude defeat by changing the ground rules of elections, spending vast sums, and stoking cultural resentment?”

“It seems, then, that we have an answer for why Republicans insist on moving forward with the American Health Care Act. Because they can. And who is going to stop them?”

[Now back to Digby:]

It appears they also have a foreign country helping them get elected, for which they seem to be very grateful.

They don’t fear the voters because they have managed to create an alternate universe for them in which everything bad that happens to them is the fault of hippies, feminazis, immigrants and people of color and everything good that happens is because of them. When liberals scream they laugh with delight because it means we are seeing justice at their hands.

And they’ve successfully created an electoral system than keeps them in the majority through undemocratic means. It’s a sweet scam. No wonder they are so confident. They have staged a silent coup and we just have to live with it.

Digby was probably having a pessimistic moment there at the end, because we don’t just have to live with it. What we need to do is pay attention, speak up and vote. But that will take time.

Now the good news. Senator Dean Heller (Republican of Nevada) came out pretty strongly against the bill today. He’s very worried about losing his job next year. That partly explains this:

“I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and tens of thousands of Nevadans,” Heller said….[To win his vote] GOP leaders would have to “protect Medicaid expansion states” from the bill’s current cuts.

“It’s going to be very difficult to get me to a yes,” he said, noting that conservative [i.e. truly radical] Republican senators would likely be reluctant to add spending back to the measure.

Another Republican Senator, Rand Paul of Kentucky, thinks the bill isn’t as cruel or “libertarian” as it could be, so he might vote against it. That would mean we’d only need one more Republican to jump ship in order to sink it.

Which might be what the Senate Majority Leader, odious Senator Mitch McConnell (also of Kentucky), is expecting to happen, according to an interesting column by Jennifer Rubin of The Washington Post. It’s called “Cheer Up, Democrats!”. Although McConnell is a terrible person, Rubin points out that he isn’t stupid. He understands that hardly anyone likes his bill. He also probably understands that there is no easy way to repeal the Affordable Care Act, despite what the Republicans have been telling their deluded supporters all these years.

So McConnell may be trying to get health care off his plate as quickly as possible, even if the vote doesn’t go his way. That will allow him and his co-conspirators to get back to what they really want to do: cut taxes, kill regulations, put poor people in jail and destroy what’s left of our democracy. (That last part is no news.) 

In America, Christianity Ain’t What It Used To Be

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If you want to understand how America got this way, reading Chris Lehmann’s book The Money Cult: Capitalism, Christianity and the Unmaking of the American Dream might help. This is from a review by Barrett Swanson at Dissent:

Though few contemporary Christians would likely admit it, many of the American colonies were built upon the idea of redistribution. Those dour Puritans who first populated the territories of New England were not lured by the promise of windfall profits. Nor had they endured months of seasickness and disease for the chance to start a small business. Instead, they were hopeless utopians, runaway apostates of the established church who yearned to embrace a higher manner of being, one founded upon a system of communitarian ethics.

John Winthrop, the Puritan governor of the Massachusetts Bay Colony, sketched the tenets of this new society in a sermon called “A Model of Christian Charity,” which he delivered in 1630 while on board a British ship headed across the Atlantic. A gusty ode to American exceptionalism, the homily christened the new continent “The City Upon a Hill,” a metaphor that Ronald Reagan would make a watchword for Republicans some three-hundred-and-fifty years later. But in Winthrop’s eyes what gave the New World its luster were the egalitarian principles of the Protestant gospel, central among them the commitment to redistributing wealth on the basis of individual need. “We must be willing,” Winthrop said, “to abridge ourselves of our superfluities for the sakes of others’ necessities . . . we must bear one another’s burdens.”

It is stupefying to consider how, over the course of four centuries, American Christianity would forsake these humble sentiments for the telegenic hucksterism of preachers like Joel Osteen. This Pentecostal quack with a garish smile doesn’t tout the spiritual benefits of communal interdependence. Nor does he acknowledge the ethical requirements of the Christian social contract. Instead, like so many stewards of the “prosperity gospel,” Osteen thinks individual wealth is a hallmark of Christian virtue and urges his followers to reach inside themselves to unlock their hidden potential…. “It doesn’t please God for us to drag through life feeling like miserable failures,” Osteen warns. “God wants you to succeed; He created you to live abundantly.”

How we got from Winthrop to Osteen is the subject of Chris Lehmann’s new book, The Money Cult. Lehmann is interested in how the communitarian spirit of mainline Protestantism was eventually tarnished by the logic of private enterprise. But in the end what he discovers is that, far from being pious victims of a rapacious economic system, mainline churches were very much complicit in “the gradual sanctification of the market.” In fact, throughout the history of the United States, Christian theology was routinely contorted to fit within the narrow priorities of capitalism.

One of the reasons Christianity caught on in the Roman world was that it functioned as a mutual aid society. Helping one’s fellow Christians made a difference in people’s lives, because Rome wasn’t big on universal healthcare or unemployment insurance. But neither was 17th century England. So it makes sense that redistribution (something along the lines of “from each according to his ability, to each according to his needs”) was a guiding principle for the Christians who founded Plymouth Colony.

Today, of course, our fellow citizens who call the U.S. a “Christian” nation think that “redistribution” is a dirty word. A headline in The Washington Post earlier this month noted that “the debate over the Affordable Care Act is really a debate over wealth redistribution”. From Karen Tumulty’s article:

Redistribution of wealth — one of the most radioactive subjects in American politics — has moved from being a subtext in the national debate over health care to being the core of it….

[There is] a bedrock philosophical and ideological question that has always been in the background of any argument about the government’s role in health care: What is the minimum that society should provide for its poorest, most vulnerable citizens, and how much should be taken from the rich and powerful to do it?

…There [are] many ways that Obamacare [redistributes] the burden of medical costs — from the sick to the healthy, with provisions such as the one denying insurers the ability to refuse coverage to people with preexisting conditions; from the old to the young, with a mandate that everyone have coverage or pay a penalty; from the rich to the poor, with an array of new taxes.

It’s almost as if right-wing opponents of the ACA don’t understand what insurance, including health insurance, is. Tumulty quotes economic historian Bruce Bartlett:

“Republicans argue that redistribution is inherently immoral without acknowledging that the very nature of insurance is redistributive. You’re taking money from people whose houses don’t burn down to give it to the people whose houses do burn down.”

As far as I know, Jesus never talked about health insurance and neither did the Puritans. But Christianity in its pure form is clearly pro-redistribution. Any preacher or politician who says otherwise shouldn’t claim to follow Jesus.

If you’re interested in reading more about Christianity as it’s frequently practiced today, I recommend a long article from 2014 by the journalist Kurt Eichenwald. It’s called “The Bible: So Misunderstood It’s a Sin”: 

…With politicians, social leaders and even some clergy invoking a book they seem to have never read and whose phrases they don’t understand, America is being besieged by Biblical illiteracy.

The Bible is not the book many American fundamentalists and political opportunists think it is, or more precisely, what they want it to be. Their lack of knowledge about the Bible is well-established. A Pew Research poll in 2010 found that evangelicals ranked only a smidgen higher than atheists in familiarity with the New Testament and Jesus’s teachings. “Americans revere the Bible—but, by and large, they don’t read it,’’ wrote … pollsters and researchers whose work focused on religion in the United States. The Barna Group, a Christian polling firm, found in 2012 that evangelicals accepted the attitudes and beliefs of the Pharisees—religious leaders depicted throughout the New Testament as opposing Christ and his message—more than they accepted the teachings of Jesus.

No doubt, Paul Ryan would beg to differ. But who sounds more like Jesus? Was it Ryan when he said the healthy shouldn’t be taxed to help the sick, or John Winthrop when he said “we must bear one another’s burdens”? Here’s a hint from the Gospel of Mark, chapter 10:  

“One thing you lack,” he said. “Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.” At this the man’s face fell. He went away sad, because he had great wealth. Jesus looked around and said to his disciples, “How hard it is for the rich to enter the kingdom of God!”

One Week and Floundering

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Eight days ago, before the inauguration, we already knew a couple of things (roughly quoting Richard Yeselson of Dissent):

  1. Our new President is an authoritarian, mentally-ill ignoramus, uniquely unfit and dangerous.
  2. The Republican Party is morally and intellectually bankrupt.

Given (1) and (2), I can’t think of anything since the inauguration that’s been more than a mild surprise. Given who he is and who his fellow Republicans are, what did we expect?

I’ll mention a few things anyway:

He gave an interview to a TV network other than Fox. Many observers thought he came across like a crazy person. One said it was the scariest thing he’d ever seen. Although many of his supporters probably enjoyed it. There’s a transcript of the interview here.

He’s still using Twitter and his outdated, easy-to-hack phone. He still spends a lot of time watching television and occasionally tweets in response to what he just heard, sometimes repeating exact phrases. One reporter said the tsunami of leaks from the White House make the President sound like a “clueless child”. I think he sounds more like an angry old fool with a severely damaged ego.

He has signed some executive orders, as new Presidents always do. For the most part, these have been aimed at impressing his supporters and may never amount to anything (he can’t get billions of dollars to build a wall by issuing an executive order). An exception is the one that will limit funding for overseas healthcare providers (the abortion “gag-rule”). It’s even worse than similar orders issued by other Republican Presidents. (Vice President Pence, who is an extreme foe of abortion rights, probably had a lot to do with it.)

Of course, that terrific replacement for the Affordable Care Act that he promised to announce in a day or two hasn’t been announced yet. But someone in the administration did take a concrete step regarding the ACA: they canceled an advertisement intended to get people to sign up for health insurance by the January 31st deadline. 

Meanwhile, The Washington Post obtained a secret recording of Congressional Republicans talking about the Affordable Care Act. It demonstrates what we already knew: they don’t know what parts of the ACA to repeal or what to replace those parts with. It’s great to hear them speak honestly for a change, so I’ve attached some choice excerpts at the bottom of this post. 

On the impeachment front, the President isn’t bothering to hide his eagerness to cash in on his new position. He doubled the membership fee at his Florida resort from $100,000 to $200,000; announced plans to build several more hotels in the US; and only plans to stop immigration from Middle Eastern countries where he doesn’t do business or doesn’t plan to (Iran bad; Saudi Arabia – where the 9/11 hijackers came from – good). A lawsuit has already been filed against the President regarding his foreign business dealings. You can read an explanation by one of the lawyers involved here and can see the formal complaint here.

Finally, the President’s spokesman announced that Mexico would reimburse us for the Wall sometime in the future, but in the meantime, companies that import stuff from Mexico (like fruits and vegetables, beer and cars) would pay for the wall through a new 20% import tariff. After it was pointed out that the tariff would be passed along to American consumers in the form of higher prices, the proposal was discounted as merely one of several ways we, not Mexico, could pay for the Wall, which, by the way, Republican politicians in Texas aren’t crazy about anyway.

As a result, and maybe in recognition of the fact that the Executive Branch of our government is now in the hands of knavish fools and foolish knaves, the President of Mexico canceled his visit to Washington.

Oh, and the President wants an investigation of the 3 million people, all of whom he knows voted for his opponent, because that’s how many more people voted for Hillary. Buenas noches, amigos.

As promised, excerpts from the Washington Post article based on that secret recording:

[A Representative] worried that one idea floated by Republicans — a refundable tax credit — would not work for middle-class families that cannot afford to prepay their premiums and wait for a tax refund…

[Another said] “It sounds like we are going to be raising taxes on the middle class in order to pay for these new credits.”

 … A freshman congressman … warned strongly against using the repeal of the ACA to also defund Planned Parenthood…

Of particular concern to some Republican lawmakers was the plan to use the budget reconciliation process — which requires only a simple majority vote — to repeal the existing law, while still needing a filibuster-proof vote of 60 in the Senate to enact a replacement….

… They did not have a clear plan on how to keep markets viable while also requiring insurers to cover everyone who seeks insurance.

[A Senator asked:] Will states have the ability to maintain the expanded Medicaid rolls provided for under the ACA, which now provide coverage for more than 10 million Americans, and can other states do similar expansions?

[A Representative] worried that the plans under GOP consideration could eviscerate coverage for the roughly 20 million Americans now covered through state and federal marketplaces and the law’s Medicaid expansion: “We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them.”

They are also still wrestling with whether Obamacare’s taxes can be immediately repealed, a priority for many conservatives, or whether that revenue will be needed to fund a transition period.

And there seems to be little consensus on whether to pursue a major overhaul of Medicaid — converting it from an open-ended entitlement that costs federal and state governments $500 billion a year to a fixed block grant…. doing so would mean that some low-income Americans would not be automatically covered by a program that currently covers 70 million Americans.

What’s Their Deal With Health Insurance Anyway?

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It feels odd to write about anything else now that a senseless, malevolent being has taken control of the White House, but here goes anyway:

Four years ago, Dr. Ben Carson, who is expected to be the U.S. Secretary of Housing and Urban Development in the new administration, compared the Affordable Care Act to slavery:

“You know, Obamacare is really I think the worst thing that has happened in this nation since slavery,” Carson … said … in remarks at the Values Voter Summit in Washington. “And it is in a way, it is slavery in a way, because it is making all of us subservient to the government, and it was never about health care. It was about control…”

“And why did [the Obama administration] want to pass it so badly? Well, as I said the other night on television, Vladimir Lenin … said that socialized medicine is the keystone to the establishment of a socialist state.”

As we might expect, there is no evidence that Lenin said any such thing. The “socialized medicine” quote attributed to him by Carson and others was fabricated for a 1949 brochure issued by the American Medical Association. That’s back when the AMA was fighting President Truman’s proposal for national health insurance (and years before they opposed Medicare). But Carson telling that tall tale helps explain why the Republican Party is so opposed to the Affordable Care Act.

The ACA requires individuals to have health insurance (or pay more income tax) and employers of a certain size to offer health insurance to their employees (or pay more income tax). It also requires that health insurance plans meet specific requirements in order to qualify as health insurance for purposes of the law. So that’s one reason Republicans want to repeal the ACA. The law requires that we do something for our own benefit or for the benefit of others. It limits our freedom to do whatever the hell we want. That makes it a prime example of government overreach, or what the right-wing calls the “Nanny State”.

But since Republicans are forced to buy insurance for their houses and cars without making a fuss (let alone bringing up slavery or Nazi Germany), being forced to buy insurance for their bodies (or their employees’ bodies) can’t be the only reason they’re against the ACA.

A second reason is simply political. After decades of trying, a Democratic President finally got a bill passed that takes us closer to universal health insurance. But whatever Obama was for, the Republicans were against. They immediately labeled the ACA as “Obamacare” to help convince right-wingers to oppose the law, even if they didn’t know what the law did (and even if the law would improve their own lives). 

That’s despite the fact that the ACA adopted the conservative approach to universal healthcare that Republicans had been advocating since the 1970s. It’s pretty amazing. A letter to the editor in The Chicago Tribune tells the disheartening story:

Obamacare is virtually the same privatized mandate plan [the Republican Party] pushed since President Richard Nixon first proposed the National Health Strategy in 1971, then again in 1974. Then the GOP revived its privatized mandate plan again in 1993 with … the [HEART] act … an alternative to the [Clinton] single-payer plan… 

Obama — as a compromise to have basic health reform passed — used this same GOP blueprint with one significant change: adding a public option alongside the GOP’s privatized mandate plan … 

Eventually the public option was stripped out of the 2010 ACA bill as a further compromise to attract bipartisan support for the bill, leaving in its place the very plan that the GOP wanted and pushed for decades. Unfortunately, the ACA did not receive a single vote from the Republican Party that created the plan’s primary concepts as an alternative to a single-payer — “Medicare for all” — type of system.

No wonder the Republicans have had so much trouble coming up with a replacement for “Obamacare”. The law they’re so against is the law they used to be for.

A third reason the Republicans oppose the ACA is that it’s the kind of Robin Hood economic redistribution Republicans hate. It takes from the rich and gives to the poor. Paul Krugman explains in a blog post called “Health Care Fundamentals”:

Providing health care to those previously denied it is, necessarily, a matter of redistributing from the lucky to the unlucky. And, of course, reversing a policy that expanded health care is redistribution in reverse. You can’t make this reality go away.

Left to its own devices, a market economy won’t care for the sick unless they can pay for it; insurance can help up to a point, but insurance companies have no interest in covering people they suspect will get sick. So unfettered markets mean that health care goes only to those who are wealthy and/or healthy enough that they won’t need it often, and hence can get insurance….

The thing is, however, that guaranteeing health care comes with a cost. You can tell insurance companies that they can’t discriminate based on medical history, but that means higher premiums for the healthy — and you also create an incentive to stay uninsured until … you get sick, which pushes premiums even higher. So you have to regulate individuals as well as insurers, requiring that everyone sign up — the mandate. And since some people won’t be able to obey such a mandate, you need subsidies, which must be paid for out of taxes…

What [the Republicans] are left with is … voodoo: they’ll invoke the magic of the market to somehow provide insurance so cheap that everyone will be able to afford it whatever their income and medical status. This is obvious nonsense [but] it’s all they’ve got.

The redistribution is related to a fourth reason they’re against the ACA and it might be their biggest reason of all. Not only did the ACA impose fines in the form of tax increases on taxpayers who wouldn’t buy health insurance, it included a separate, relatively large tax increase on the richest Americans. As everyone knows, that‘s anathema to Republican politicians. Repealing the ACA, therefore, would mean a big tax cut for the Republicans’ favorite people. From Slate:

One of the core, very simple things [the ACA] did was raise taxes on the wealthy in order to fund subsidized health care for more Americans. Couples earning more than $250,000 saw a 0.9 percent increase in their top Medicare tax rate, as well as a new, 3.8 percent Medicare surtax on investment income.

If Republicans have their way and successfully repeal the Affordable Care Act, those two taxes will be toast—which will mean a substantial break for some of the country’s wealthiest families. The liberal Center on Budget and Policy Priorities estimates that millionaires would see 80 percent of the benefits from those tax reductions. Based on the most recent IRS data, the think tank roughly projects that the 400 highest income households—which earned an average of more than $300 million each in 2014—would see a $2.8 billion annual tax cut, worth about $7 million on average per filer.

So that’s at least four reasons why Republicans want to scrap the Affordable Care Act:

1) It’s what they call the “Nanny State” in action. 

2) It was an important Obama accomplishment.

3) It’s the kind of redistribution Robin Hood was for and the bad guys were against.

4) It raised taxes, especially for the rich.

In conclusion, Republicans don’t necessarily want millions of Americans suffering and dying without medical treatment. Being concerned about that kind of thing is simply low on their list of priorities.