For as long as Republicans preached the gospel of “repeal and replace” and then just “repeal” Obamacare, they also assured everyone that the popular parts of the Affordable Care Act would remain. Keeping your kids on your insurance policy until they are 26 would stay. So, too, would the ban on denying coverage due to a preexisting condition. But in an interview with Al Hunt of Bloomberg News, Ryan let the cat out of the bag. Repeal of Obamacare would mean repeal of everything.

Here’s the exchange between Ryan and Hunt. Read it carefully, and I’ll meet you on the other side.

HUNT:  You think it will be repealed?
RYAN:  I don’t think it can last. Yes. I think the architecture of this law is so fundamentally flawed that I think it’s going to collapse under its own weight. And the sooner those of us who want true, real reform can show a better way forward, the faster we can repeal.
And, yes, I really do believe in the next administration with a better Congress that we will replace this law and save the health care system from this really ugly moment that’s —
HUNT:  Let me ask you then about what you — some of the things you might replace or not replace, just a couple provisions that are popular. There’s some of Obamacare that — it bans insurance companies from discriminating for preexisting conditions. It lets you keep kids on your insurance until you’re 26.  It bars insurance companies from creating different rates for people with — who engage in physical labor, like roofers and waitresses. It closes the donut hole, $10 billion more for senior, for prescription drugs.
Will those all survive?  Will they be changed?
RYAN:  So we can go through each one of those? And I have an answer specifically for each one of those, but if you look at these kinds of reforms, where they’ve been tried before, say the state of Kentucky, for example, you basically make it impossible to underwrite insurance.  You dramatically crank up the cost.  And you make it hard for people to get affordable health care.
Here’s the argument I would make. We can have in this country universal access to affordable health insurance for everybody, including people with preexisting conditions without a costly government takeover of one-sixth of our economy.
HUNT:  And you think —
RYAN:  We can do that. And I think there are better ideas and better reforms for getting at these very serious issues without these kinds of things that needlessly jeopardize the health care for people who–
HUNT:  To keep all those protections, kids on —
RYAN:  Yes, that was — that particular one was in the Republican alternative —
HUNT:  — and not discriminate against people who do physical labor, like roofers and —
RYAN:  There are better ways of dealing with those particular issues.
HUNT:  But still be covered?
RYAN:  Yes, and I think there are better ways of dealing with those very serious and legitimate issues without doing it this way, because I think this is the wrong approach.
HUNT:  And the same thing with filling the donut hole, so-called donut hole?
RYAN:  Look, how long do you have?  Do you want to get into it all?
HUNT:  No.

According to Ryan, Obamacare will collapse under its own weight. Not only must the law be repealed, but the provisions that are more popular than the law that makes them possible must go, too. He says they must be replaced by “better ways of dealing with those very serious and legitimate issues” without ever articulating what those “better ways” are.

“In the interview, Congressman Ryan did not substantively respond to the question of how he would provide consumer protections for individuals with health issues in a more effective way than the Affordable Care Act,” said Linda Blumberg of the Urban Institute. “For a while, Republicans were saying they would keep the popular parts. But that was folly from my perspective.” That’s because you have to think of the ACA as a machine with a series of interlocking gears needed for proper and effective operation. Remove one and the whole thing falls apart.

Let’s take the provision that requires insurers to provide health coverage to those with preexisting conditions. As Blumberg explained to me yesterday, “If you have the preexisting condition provision but don’t require insurers to issue a policy to all applicants, it won’t help anyone who needs it. If you have guaranteed issue but don’t require the same premiums regardless of health status, the sick won’t be helped” because then insurance companies could charge astronomical rates for policies that would make it difficult if not impossible for those with preexisting conditions to afford them. And “if the other protections are in place but there is no individual mandate, then people will get coverage only after they get sick and that would collapse the entire private insurance market.”

We can’t have that happen. Not when the number of uninsured is falling fast. According to the latest Gallup poll, “the uninsured rate dipped to 15.6% in the first quarter of 2014, a 1.5-percentage-point decline from the fourth quarter of 2013. The uninsured rate is now at the lowest level recorded since late 2008.” Gallup also said it was “a sign that the Affordable Care Act, commonly referred to as ‘Obamacare,’ appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage.”

Because repealing Obamacare would strip millions of people of health insurance, Ryan’s “better ways” word salad and its dearth of details are beyond inadequate. The ACA has been the law of the land for four years and was upheld as constitutional by the Supreme Court two years ago. That House Majority Leader Eric Cantor (R-Va.) today is saying his members are working on an alternative to Obamacare and need to “coalesce around a plan” is ridiculous. 

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