Republicans have tried to sabotage the Affordable Care Act since it passed. Now they are using one of the messes they have made as evidence that they should replace the law.
House Speaker Paul Ryan (R-Wis.) released an Obamacare replacement plan on Wednesday that, among other things, complains that the ACA leaves people out. In many states, some low-income people are eligible neither for Medicaid, a public health-care program for the poor, nor for Obamacare subsidies, which help those higher up the income scale buy private plans. Ryan’s document rightly points out that this coverage gap is a major failure. Then it blames the gap on “Obamacare’s poor design and incentives.”
This is an outrageous distortion. The coverage gap is not a design glitch. It is the direct result of anti-Obamacare hysteria in Ryan’s party.
After the ACA passed, the Supreme Court ruled that the Medicaid expansion must be optional for states. The terms were so good for state leaders — the federal government promised to pay nearly the whole cost to cover lots of vulnerable people — it seemed inconceivable that any of them would refuse to expand Medicaid within their borders. But this thinking did not account for the anti-Obamacare tantrum the GOP has thrown over the past six years. Nineteen states have refused to expand Medicaid in rote Republican opposition to the ACA.
Obamacare’s drafters did not foresee this irrational turn of events. They expected that people below a certain threshold would be on Medicaid and those above that threshold would be on marketplace subsidies. So they did not offer subsidies to those they thought would be on Medicaid. When Republican states refused to expand Medicaid, they created an eligibility gap hitting millions of people the law’s authors reasonably expected would have coverage.
Republicans had — in fact, have — at least two ways to avoid this result. State GOP leaders could have simply expanded Medicaid in their states, as many observers assumed they would, apparently giving them too much credit. Or Republicans in Congress could have agreed to extend eligibility for marketplace subsidies downward, solving this gross and unnecessary inequity without requiring the states to do a thing. Instead, Republicans chose not only to create the gap, but also to keep it in place. Their continued inaction hurts low-income people in those 19 states. And Ryan has the nerve to complain about it — even to use it as evidence that the ACA is fatally flawed.
Rather than offer a believable alternative to Obamacare, Ryan released a document that not only contains this shameless deception and other claims that warp the reality of the law’s rollout, but also lacks crucial details about how it would reshape the health-care system. Rather than prove that the GOP can govern, it makes the Republican position on Obamacare look weak.