What does Sheldon Adelson have to do with a disabled coal miner receiving Medicaid benefits? Let’s consider that question.

Mr. Adelson is an extremely successful businessman.

His contribution to the betterment of mankind is derived from ownership of a reported 392,735,403 shares in his casino company, Las Vegas Sands. He is believed to have a total personal wealth of $36 billion dollars.

Assuming Las Vegas Sands pays an annualized dividends of $2.92 per share, as has been reported elsewhere, Mr. Adelson would receive $1.14 billion in income from dividends in 2017.

In the Affordable Care Act, there is currently a 3.8 percent tax on investment income – dividends and capital gains – for individuals with more than $200,000 in annual earnings, or $250,000 for a couple.

Note, this tax is on investment income only. Other sources of income are not involved.

Under the ACA, money from this tax goes to fund expenditures for expansion of Medicaid and tax credits that offset the cost for folks to get insurance from individual health insurance exchanges.

Among the other modest proposals in the Trumpcare plan is deleting this tax and other taxes included in the ACA.

If you do the math, 3.8 percent on investment income of $1.4 billion dollars comes out to roughly $44 million dollars.

So, with this tax deleted, Mr. Adelson stands to save $44 million.

And what does that have to do with a disabled coal miner living on Medicaid benefits?

That $44 million is equivalent to the government’s Medicaid bill to cover about 7,670 Americans, including that disabled miner. (Numbers from Business Insider, June 22, 2017)

I don’t mean to pick on Mr. Adelson. Nor do I begrudge him his wealth (although if he can’t subsist on $ 1,356,000,000, not counting additional income or other taxes this year, he needs to talk to his accountant.)

The non-partisan Congressional Budget Office estimates that proposed tax cuts under the House version of “Repeal and Replace” will reduce tax revenues to the national treasury by $1 trillion over 10 years. The revenue shortfall under the Senate version is estimated to be roughly similar.

So who must shoulder the burden of revenues lost to make possible Mr. Adelson’s windfall – and the windfall of all others currently subject to the tax?

Well, that would be the disabled coal miner. He, and all others receiving Medicaid coverage, will pay for Mr. Adelson’s windfall in the form of reduced benefits from a gutted Medicaid program.

Bottom line? All this hoopla in Washington is not about health care at all. It’s about finding monies to pay for a tax break for the very wealthy. And it’s aimed at the folks least able to pay it, and equally, least able politically to oppose it.

And it’s not just ordinary folks who are about to get hammered.

Rural hospitals depend on Medicaid reimbursements to keep their doors open.

According to the North Carolina Rural Research Program, about 80 rural hospitals have already gone belly up since 2010. According to a study by Chartis Center for Rural Health, 673 additional rural hospitals are teetering on the edge of insolvency if their income from Medicaid reimbursement is cut.

When those hospitals treat a non-insured patient (since, as the GOP leadership readily points out, there is always “access” to health care), those costs are passed along to the rest of us. Nothing costs nothing.

By definition, you find rural hospitals in rural areas. You find them in those rural counties that reliably turn bright red every election.

When folks in those counties are driving a few counties over for whatever treatment they need, emergency or otherwise, they have their very own Republican congressional delegation to thank.

As I’m sure Mr. Adelson, and others similarly situated, thank them as well.