Preserve

Reporting from Washington — As they wrestle with how to replace the Affordable Care Act, Senate Republicans face a critical choice between cutting taxes or preserving health coverage for millions of Americans, two competing demands that may yet derail the GOP push to roll back the 2010 healthcare law.

House Republicans, who passed their own Obamacare repeal measure this month, skirted the dilemma by cutting both taxes and coverage.

Their bill — embraced by President Trump — slashed hundreds of billions of dollars in taxes, a key goal of GOP leaders and the White House as they seek to set the stage for a larger tax overhaul later this year.

At the same time, the House legislation cut more than $1 trillion in healthcare assistance to low- and moderate-income Americans, a retrenchment the nonpartisan Congressional Budget Office estimates would nearly double the ranks of the uninsured over the next decade to more than 50 million.

In the Senate, coverage losses on that scale are worrisome to many rank-and-file Republicans whose states have seen major coverage gains under Obamacare. That makes the preservation of benefits one of the biggest challenges confronting Senate Majority Leader Mitch McConnell (R-Ky.) and other GOP leaders.

“Coverage matters,” Sen. Bill Cassidy (R-La.) said last week on MSNBC’s “Morning Joe” program, noting the importance of preserving Medicaid spending in the current law. “To someone [who] is lower-income, you’re going to need those dollars to cover that person.”

Yet moderating cuts to Medicaid and other government health programs without driving up budget deficits could force Republican senators to also dial back the tax cuts that many in the GOP want.

“It’s not that complicated. … If you want to use money for tax reform, you can’t have it for health coverage,” said Gail Wilensky, a veteran Republican health policy expert who ran the Medicare and Medicaid programs under President George H.W. Bush. “You can’t do both.”

McConnell convened a group of GOP senators — quickly panned for including only white men — to develop Obamacare replacement legislation, though the panel largely excluded Republican lawmakers who are most concerned about coverage, including Cassidy. McConnell has since said that all Senate Republicans would be involved in developing an Obamacare replacement.

The trade-off between cutting taxes and preserving Americans’ health protections reflects, in part, the legislative procedure that congressional Republicans have chosen to repeal the Affordable Care Act.

That process, known as budget reconciliation, allows Senate Republicans to pass their Obamacare repeal with a simple majority, rather than the 60-vote super-majority that is usually required to pass controversial legislation. (Republicans have only a 52-48 majority in the Senate.)

But to qualify for budget reconciliation under Senate rules, the bill must reduce the federal deficit over the next decade.

Tax cuts alone typically do the opposite, driving up budget deficits.

The tax cuts in the House Republican healthcare bill total more than $600 billion over the next decade, according to independent analyses by the Congressional Budget Office and the congressional Joint Committee on Taxation.

They include most of the major taxes enacted in the 2010 health law to fund the law’s program for extending health insurance to more than 20 million previously uninsured Americans.

On the chopping block are taxes on medical device makers and health insurance plans, which together account for about $165 billion in tax cuts over the next decade.

Couples making more than $250,000 a year (and single taxpayers making more than $200,000) would see two tax cuts, including one on investment income, that the budget office estimated would cost the federal government nearly $300 billion over the next decade. (That estimate may be revised down as House Republicans delayed one of the tax cuts in the final version of their bill.)

Also eliminated would be a host of limits on tax-free spending accounts that many Americans use for medical expenses. Republicans argue these taxes are unnecessary and even undermine efforts to control healthcare costs.

“It’s bad for economic growth,” House Speaker Paul D. Ryan (R-Wis.) told Fox News during the House debate.

The tax on health plans, for example, is widely seen as contributing to higher premiums, as insurers customarily pass the costs along to consumers.

But eliminating so many taxes isn’t cheap.

So the Republican healthcare bill — known as the American Health Care Act — slashes hundreds of billions of dollars in federal healthcare spending, including an estimated $880 billion in federal money for Medicaid, the state-run government health plan for the poor that currently covers more than 70 million Americans at any one time.

That would in effect cut federal Medicaid spending by more than a quarter over the next decade, an unprecedented reduction that independent analyses suggest would force states to sharply limit coverage for poor patients.

The House bill would also reduce insurance subsidies now available to low- and moderate-income Americans who get health plans through Obamacare marketplaces such as HealthCare.gov.

The reduction in federal aid would, in turn, dramatically increase the number of uninsured Americans. Overall, the Congressional Budget Office has estimated that 24 million fewer people would have health coverage by 2026 under the original version of the House bill.

By contrast, the wealthiest Americans stand to get a large tax break. By 2023, families making more than $1 million would see their taxes decrease by an average of more than $50,000, an analysis by the independent Urban-Brookings Tax Policy Center suggests.

That means that in a country of more than 300 million people, nearly half of all the tax breaks in the House healthcare bill would go to only about 780,000 households.

The combination of tax breaks for wealthy Americans and historic reductions in assistance to low-income patients has fueled widespread criticism of the House GOP healthcare legislation, particularly on the left.

“The math is pretty clear,” said Edwin Park, vice president for health policy at the liberal Center on Budget and Policy Priorities. “They are sharply cutting Medicaid and insurance subsidies to pay for tax cuts.”

Whether GOP senators will be able to moderate the reductions in healthcare assistance remains unclear.

The early version of the House bill was projected to reduce the federal deficit by about $150 billion over the next decade, according to the Congressional Budget Office analysis.

That number has likely shrunk slightly, as House Republicans added more spending to the legislation before it passed last week. An updated budget analysis is expected next week.

But under the budget rules adopted by GOP lawmakers this year, Senate Republicans will not be able to add any spending into their legislation without enacting cuts elsewhere or shrinking the tax cuts further.

That is because according to those rules, their bill must reduce the deficit by as least as much as the House bill.

Obamacare vs. Trumpcare: A side-by-side comparison of the Affordable Care Act and the GOP’s replacement plan »

Obamacare 101: A primer on key issues in the debate over repealing and replacing the Affordable Care Act. »

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A famous Civil War-era photo of an escaped slave who had been savagely whipped. Displays detailing how more than 120,000 U.S. citizens of Japanese ancestry were forcibly imprisoned during WWII. Signs describing the effects of climate change on the coast of Maine.

In recent months, a small army of historians, librarians, scientists and other volunteers has fanned out across America’s national parks and museums to photograph and painstakingly archive cultural and intellectual treasures they fear are under threat from President Trump’s war against “woke.”

These volunteers are creating a “citizen’s record” of what exists now in case the administration carries out Trump’s orders to scrub public signs and displays of language he and his allies deem too negative about America’s past.

More than 120,000 people of Japanese ancestry were forcibly relocated and incarcerated in camps during World War II, including these Japanese Americans seen at Manzanar in the Owens Valley in 1942.

(LA Library)

“My deepest, darkest fear,” said Georgetown University history professor Chandra Manning, who helped organize an effort dubbed Citizen Historians for the Smithsonian, is that the administration plans to “rewrite and falsify who counts as an American.”

In March, Trump issued an executive order entitled “Restoring Truth and Sanity to American History” arguing that, over the past decade, signs and displays at museums and parks across the country have been distorted by a “widespread effort to rewrite our Nation’s history,” replacing facts with liberal ideology.

“Under this historical revision,” he wrote, “our Nation’s unparalleled legacy of advancing liberty, individual rights, and human happiness is reconstructed as inherently racist, sexist, oppressive, or otherwise irredeemably flawed.”

He ordered the National Parks Service and The Smithsonian to scrub their displays of content that “inappropriately disparages Americans” living or dead, and replace it with language that celebrates the nation’s greatness.

The Collins Bible — a detailed family history recorded by Richard Collins, a formerly enslaved man — is seen at the National Museum of African American History and Culture in Washington, D.C.

(Kent Nishimura/Los Angeles Times)

That’s when Manning’s colleague at Georgetown University, James Millward, who specializes in Chinese history, told her, “this seems really eerie,” Manning recalled. It reminded him of the Chinese Communist Party’s dictates to “tell China’s story well,” which he said was code for censorship and falsification.

So the professors reached out to friends and discovered that there were like-minded folks across the country working like “monks” in the Middle Ages, who painstakingly copied ancient texts, to photograph and preserve what they regarded as national treasures.

“There’s a human tradition of doing exactly this,” Manning said. “It feels gratifying to be a part of that tradition, it makes me feel less isolated and less alone.”

Jenny McBurney, a government documents librarian at the University of Minnesota, said she found Trump’s language “quite dystopian.” That’s why she helped organize an effort called Save Our Signs, which aims to photograph and preserve all of the displays at national parks and monuments.

The sprawling network includes Manzanar National Historic Site, where Japanese American civilians were imprisoned during the Second World War; Fort Sumter National Monument, where Confederates fired the first shots of the Civil War; Ford’s Theater National Historic Site in Washington, D.C., where Abraham Lincoln was assassinated; and the Martin Luther King, Jr. National Historic Park.

It would be difficult to tell those stories without disparaging at least some dead Americans — such as the assassins John Wilkes Booth and James Earl Ray — or violating Trump’s order to focus on America’s “unmatched record of advancing liberty, prosperity and human flourishing.”

At Acadia National Park in Maine, where the rising sun first hits the U.S. coast for much of the year, signs describing the effect of climate change on rising seas, storm surge and intense rain have already been removed.

McBurney doesn’t want volunteers to try to anticipate the federal government’s next moves and focus only on displays they think might be changed, she wants to preserve everything, “good, bad, negative or whatever,” she said in a recent interview. “As a librarian, I like complete sets of things.”

And if there were a complete archive of every sign in the national park system in private hands — out of the reach of the current administration — there would always be a “before” picture to look back at and see what had changed.

“We don’t want this information to just disappear in the dark,” McBurney said.

Another group, the Data Rescue Project, is hard at work filling private servers with at-risk databases, including health data from the Centers for Disease Control, climate data from the Environmental Protection Agency and the contents of government websites, many of which have been subject to the same kind of ideological scrubbing threatened at parks and museums.

Both efforts were “a real inspiration,” Manning said, as she and Millward pondered what they could do to contribute to the cause.

Then, in August, apparently frustrated by the lack of swift compliance with its directives, the Trump administration sent a formal letter to Lonnie G. Bunch III, the first Black Secretary of the Smithsonian, setting a 120-day limit to “begin implementing content corrections.”

Days later, President Trump took to Truth Social, the media platform he owns, to state his case less formally.

“The Smithsonian is OUT OF CONTROL,” he wrote, “everything discussed is how horrible our Country is, how bad Slavery was, and how unaccomplished the downtrodden have been.”

Even though the Smithsonian celebrates American astronauts, military heroes and sports legends, Trump complained that the museums offered nothing about the “success” and “brightness” of America, concluding with, “We have the “HOTTEST” Country in the World, and we want people to talk about it.”

People visit the Smithsonian Museum of American History on the National Mall in Washington.

(Pablo Martinez Monsivais / Associated Press)

Immediately, Manning and Millward knew where they would focus.

They sent emails to people they knew, and reached out to neighborhood listservs, asking if anyone wanted to help document the displays at the 21 museums that make up the Smithsonian Institution — including the American History Museum and the Natural History Museum — the National Zoo and the United States Holocaust Memorial Museum.

Within about two weeks, they had 600 volunteers. Before long, the group had grown to over 1,600, Manning said, more people than they could assign galleries and exhibitions to.

“A lot of people feel upset and kind of paralyzed by these repeated assaults on our shared resources and our shared institutions,” Manning said, “and they’re really not sure what to do about it.”

With the help of all the volunteers, and a grad student, Jessica Dickenson Goodman, who had the computer skills to help archive their submissions, the Citizen Historians project now has an archive of over 50,000 photos and videos covering all of the sites. They finished the work Oct. 12, which was when the museums closed because of the government shutdown.

After several media outlets reported on the order to remove the photo of the whipped slave from the Fort Pulaski National Monument in Georgia — citing internal emails and people familiar with deliberations who spoke on the condition of anonymity because they were not authorized to comment publicly — administration officials described the reports as “misinformation” but declined to specify which part was incorrect.

A National Parks Service spokesperson did not respond to requests for comment for this story.

But the possibility that the administration is considering removing the Scourged Back photo is precisely what has prompted Manning, and so many others, to dedicate their time to preserving the historical record.

“I think we need the story that wrong sometimes exists and it is possible to do something about it,” Manning said.

The man in the photo escaped, joined the Union army, and became part of the fight to abolish slavery in the United States. If a powerful image like that disappears from public display, “we rob ourselves of the reminder that it’s possible to do something about the things that are wrong.”