The gory details of the Congressional Budget Office’s report on the House legislation to “repeal and replace” Obamacare are, in many ways, superfluous. The bill’s flaws, substantive and otherwise, have long been evident. Less clearly understood, though equally disturbing, is the larger political context.

That’s not to say the particulars of the CBO report, released Wednesday, are irrelevant: far from it. The report says the Republican effort would increase the number of uninsured by 14 million in 2018, rising to 23 million in a decade.

Millions would lose coverage due to the bill’s cuts to Medicaid. Others would lose it because people who are older, sicker or both would find they are priced out of useful insurance. People with pre-existing health conditions would, once again, be at the actuarial mercy of insurance companies that were never organized to be charities.

These numbers fill in the big picture, which looks something like this: Health care, which depends on highly skilled labor and sophisticated technology, is expensive. Insurance to pay for that care, therefore, is also expensive. It is especially expensive for people who are, due to misfortune or advancing age, prone to costly illnesses.

Providing health insurance to more people, then, requires more money. A lot more. The Affordable Care Act imposed a range of taxes, including a special Medicare surcharge on high earners, to pay for these costs.

The Republican plan, the American Health Care Act, repeals those and other taxes, totaling some $662 billion over 10 years. It also cuts Medicaid funding by $834 billion over a decade.

The bill would provide some funding for tax credits and high-risk pools. But mostly it transfers money currently used to pay for care for the sick and poor to the nation’s wealthiest taxpayers. (According to one estimate, the bottom 80 percent of income earners would see little or no benefit from the plan’s tax cuts.)

Because that upward redistribution of money is politically unpopular, and literally deadly, House Republicans sought to camouflage the basic trade in which they are engaged -- reducing access to health care in exchange for tax cuts for the wealthy. The CBO report merely exposed what was obvious all along.

Instant Insights /

Exposing the obvious about the GOP health care bill

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