There’s a dollop of cream on top of the shit sandwich that is the Trump-backed lawsuit in front of the Supreme Court to overturn the Affordable Care Act (ACA). That’s of course the big sweetener for the people who matter most to Republicans: the Uber Rich. It’s not just taking health care away from the plebes, as satisfying as that would be for Republicans. No, it has to come with a hefty tax cut for the wealthiest—and of course it does.
The highest income 0.1% of households—those making more than $3 million annually—will get tax cuts to the tune of $198,000 if the law is completely overturned, the Tax Policy Center estimates. Now, $200,000 to someone making more than $3 million is more or less couch change, but you can bet they won’t turn it down. It’s not just the richest among us who gain. Those making over $1 million a year would see about $42,000 back in tax cuts. The total loss of revenue should the law be overturned would be about $30 billion in 2020. That itself would pay for Medicaid coverage for more than 4 million people, just for some perspective. (By the way, if the law goes down, Medicaid expansion goes with it.)
The taxes involved are mostly on high earners in their Medicare taxes. The ACA has a a 0.9% tax on earnings over $250,000 for couples ($200,000 for single filers), with the revenue going to the Medicare Trust Fund. So the repeal would also destabilize Medicare, which is a side bonus for Republicans. The law imposed a larger, 3.8% tax on unearned income (capital gains, dividends, taxable interest, and royalties) for couples with incomes over $250,000 ($200,000 for single filers). The loss of various other revenue generators in the law—a $2.8 billion annual fee on pharmaceutical companies, limits on contributions to medical Flexible Spending Accounts, and the ACA employer mandate requiring large employers to provide health care to workers—all contribute to the overall losses.
Which means, as the Center on Budget and Policy Priorities (CBPP) spells out, a decision by the Supreme Court to destroy the law (and at least part of the intent of Trump and the Republican attorneys general pushing the case) would “transfer billions of dollars each year from low- and moderate-income people (who would lose subsidized health coverage) to high-income households and corporations (which would receive large tax cuts).” They calculated those numbers all the way down the tax rates, with the vast majority of Americans who make less than $250,000 getting $100 or less. The people at the very top, those in the top 1%, would get more than two-thirds of the total cuts. They could spend all that money on their gold-plated health care.
The CBPP also points out that the end of Obamacare would result in even wider health and income gaps for people of color, citing an Urban Institute analysis from before the coronavirus pandemic. It projects that the loss of the law “would cause nearly 1 in 10 non-elderly Black people, and 1 in 10 Hispanic people, to lose coverage, compared to about 1 in 16 white people.” In addition, the tax cuts “would flow disproportionately to white households, which are three times likelier than Black or Hispanic households to be in the top 1 percent of the income scale.”
That, of course, is baked into the entire calculation behind getting rid of Obamacare. Racism is a component of pretty much everything Republicans do.