The bottom line: The bill is cruel.

Republicans don’t care about hurting people.

(C-SPAN2 greengrab)

Senate Republicans certainly lack spine. They are deathly afraid to cross Donald Trump, to put their cushy jobs at risk by provoking a primary challenge, to fall out of favor with the maliciously dishonest right-wing media, and/or to be ostracized from their close circle of sycophants, donors, and staff. But their greatest moral failure is arguably not lack of courage but rather lack of empathy. They simply do not care about the pain they are inflicting on others.

Senate and House Republicans know what this bill does. Sen. Ron Johnson (R-Wis.) and others can repeat the lie that no one will lose coverage, but it does not make it so. Seventeen million people will lose health care (including 11 million Medicaid beneficiaries). Millions will lose food assistance. The debt will grow by over $3 trillion. It is hard to find anyone outside the MAGA cult who thinks this will benefit America. Republicans respond by lying about the bill even when confronted with the misery their handiwork will cause.

“The facts matter. The people matter. The Senate’s Medicaid approach breaks promises and will kick people off of Medicaid who truly need it,” Sen. Thom Tillis (R-N.C.) said on the floor, finally freed to speak honestly after announcing he would not seek reelection. His fellow Republicans shrugged. They heard the same litany of horrors from constituents, hospitals, doctors, state officials, and even right-wing think tanks.

Republicans still cannot imagine if they or a loved one:

• Could not get food because their application for food stamps was snarled in red tape designed to kick people off benefits to which they were entitled;

• Could not get preventive care, addiction treatment, nursing home care, or prescription drugs because they have been kicked off Medicaid and priced out of the Affordable Care Act exchanges;

• Could not get to a rural hospital in an emergency after the local one closed;

• Could not find a cancer trial after cuts to the National Institutes of Health;

• Could not get care from Veterans Affairs.

Republicans refuse to admit that they are hurting ordinary, hard-working Americans trying to provide for themselves and their families. To do otherwise would be a confession of their inhumanity. Instead, using well-worn authoritarian techniques (e.g., demonization, dehumanization, and marginalization), MAGA politicians convince themselves that those who rely on vital benefits are unfit and undeserving. Republicans dub them “rats” or “vermin” or “murderers.”

Republicans’ cynicism might not surprise us, but it should horrify us. Alaska’s two senators, Lisa Murkowski and Dan Sullivan, both Republicans, know what the bill does to their state. If they did not before, the state house speaker (an independent) and state Senate majority leader (a Republican) spelled it out in a New York Times op-ed last Friday.

“The benefits of Medicaid and the SNAP program permeate the entire fabric of the Alaska economy, with one in three Alaskans receiving Medicaid, including more than half of the children,” they wrote. “In remote Arctic communities, Medicaid dollars make medical travel possible for residents from the hundreds of roadless villages to the communities where they are able to receive proper medical treatments.”

Murkowski and Sullivan voted for it anyway, trying to carve out exceptions to protect their state, what Democrats have dubbed the Polar Payoff. Though Murkowski bargained for minimal relief on SNAP and a drop more money to stave off rural hospital collapses, thousands of her constituents will still get thrown off Medicaid and the ACA.

MSNBC reported on Murkowski’s explanation:

“We do not have a perfect bill by any stretch of the imagination,” Murkowski told reporters. “My hope is that House is going to look at this and recognize that we’re not there yet.” In a separate interview, Murkowski said, “Do I like this bill? No."

Her decision to vote for the bill now looks even more outlandish and inexcusable. If you wonder how these people sleep at night, you are not alone.

Let’s not forget Iowa’s Republican Sen. Joni Ernst, who ghoulishly said we are all going to die anyway. Well, many people will die prematurely in her state. A medical student and a doctor wrote for the Des Moines Register: “Medicaid enrollment in Iowa is between 600,000 to 850,00 in any given month since 2020. In 2022, the federal government covered 72.6% of Iowa’s $6.9 billion Medicaid costs, ensuring access to doctors, prescriptions and hospital care.”

Moreover, “Rural hospitals are the backbone of Iowa’s communities, providing everything from emergency care to maternity services,” they explained. “Cuts to Medicaid would mean less revenue to these hospitals and could push many to the brink—out of Iowa’s 93 hospitals, 31 hospitals have already lost services, 20 are at risk of closure, and five face immediate shutdown.” Moreover, where are Iowans who are not on Medicaid supposed to go if a rural hospital leaves them hundreds of miles from the closest facility?

And no one should give a pass to Sen. Susan Collins (R-Maine), who preens as defender of abortion rights but cast deciding votes to put two anti-Roe justices on the Supreme Court and who poses as a defender of Medicaid but advanced to the floor a bill slashing over $1 trillion from the program. She safely voted no when the bill came to a final vote, but she had already voted with her party when it mattered.

Surely, she saw home-state headlines. (“Collins could toe the line or stand up for Maine with her mega-bill vote,” said one. She fell into line when it mattered.) She could have followed the lead of her fellow Mainer, Sen. Angus King (I), who denounced the bill. “This bill isn't just irresponsible, it's cruel." He continued, "It is literally taking food and health care away from lower income and middle income people to give a tax break to millionaires.” Collins is second to none in rationalizing horrible votes. Perhaps Maine voters will finally see through her abject hypocrisy and send her into retirement in 2026.

If the bill passes the House, the pain in all 50 states will no longer be abstract. MAGA Republicans’ betrayal will hurt and, yes, kill tens of thousands of Americans. And everyone will know which party is responsible. Republicans have no plausible excuse for putting the interests of billionaires over those of ordinary people.

The Alaska state legislators in their op-ed asked: “What is the end game here? How does it help anyone to terminate health care coverage for our most vulnerable through red tape or take away food for families who have limited to no options for gainful employment?” Well, it helps billionaires, and it allows lawmakers to stay in power, if the voters put up with it.

If voters are horrified, they cannot forget that Republicans are solely responsible for the cruelest, most destructive, and most inhumane bill in decades. At the first opportunity, voters must boot them out of office.

The bill now moves to the House, where every Republican who votes for this cruel compact will soon face the wrath of voters. Let’s see if any have more nerve (or political sense) than their Senate counterparts.

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