Not so long ago, President Trump vowed that “everybody” would be covered under the Republican replacement for the Affordable Care Act. On Sunday, Health and Human Services Secretary Tom Price vowed that “nobody will be worse off financially” under the GOP’s American Health Care Act, an assertion so preposterous that it makes President Obama’s “You can keep your doctor” declaration seem trivial.
In fact, we already know that lots and lots of people will be worse off financially. The people who will fall off Medicaid will be worse off. In most states, the poorer, older, sicker people will be worse off because the GOP’s tax credits will be less generous than the subsidies they receive under Obamacare. (It’s no answer to say to such people that health savings accounts can make up the difference when they live paycheck to paycheck without surplus to contribute to their own health care.) The bill has to be less generous to such people because it entails a gigantic tax cut for the rich.
Whether it was Price, Speaker of the House Paul Ryan (R-Wis.) or Office of Management and Budget Director Mick Mulvaney spinning on Sunday, the logical flaws, unfounded assertions and obliviousness to the country’s mood suggested they are either clueless politicians or simply want to pass something, send it over to the Senate and let it die there.
Ryan insists they have to pass this bill because Obamacare is “failing.” (“Obamacare is collapsing,” he declared on Face the Nation. “If we just did nothing, washed our hands of the situation, we would see a further collapse of the health insurance markets.”) Even if you believe that you surely could come up with something else.
Mulvaney, appearing on ABC’s “This Week with George Stephanopoulos” asserts that no one cares that the AHCA is a giant giveaway to the rich:
STEPHANOPOULOS: But the burden may be falling hardest on older, middle-income Americans. And your critics — critics are saying this massive transfer of wealth from lower-income Americans to upper-income Americans, when you combine the tax cuts with the loss in subsidies for middle-income Americans.
MULVANEY: I’m not sure where they’re getting a massive of transfer wealth. George, what we’re doing is making sure that the truly indigent still have care. Medicaid is still there. In fact, we think it’s going to be even better. The people who are just above Medicaid but still have difficulty buying their own premiums will not only have the refundable tax credit, but they’ll have the ability to use HSAs to pay for their — to pay for their healthcare on a tax-advantaged basis just like you and I get. So I don’t understand the criticisms lobbed in that fashion.
The bill actually helps a great many people and helps them get something they need, which is healthcare, not health coverage.
STEPHANOPOULOS: Millions are going to be paying more and the wealthy are going to be getting a tax cut.
Ryan doesn’t think it’s fair to count coverage numbers because anyone who doesn’t get coverage in the future will be among those who don’t want coverage. “People are going to do what they want to do with their lives because we believe in individual freedom in this country,” he said. “So the question is, are we providing a system where people have access to health insurance if they choose to do so?” Hmm, he conveniently ignores the people who will once again be priced out of the market. Does he imagine that everyone who loses coverage under his scheme will be someone who doesn’t want coverage anyway?
At times Ryan seemed downright dishonest, along with Mulvaney prospectively trashing the Congressional Budget Office scoring on the bill due to come out today or tomorrow. He claimed not to know about Trump’s promises to cover everybody. (“I can’t speak to all of those. I don’t know exactly all that all that he said.”) That’s absurd; every newspaper in the country reported on them. He asserted that he does not know how many will lose coverage when surely he has previewed what is coming from the CBO scoring. He suggested that there is no individual mandate under the GOP plan when in fact there is a 30 percent penalty for trying to buy into the system by dropping continuous coverage.
He claims, “Risk pools work very, very well. We had them in Wisconsin.” In fact they’ve repeatedly failed. “Most States do not provide additional premium subsidization for low-income pool applicants. Therefore, for much of the high-risk target population (the medically uninsurable) high-risk pool coverage is unaffordable,” one report found. The Kaiser Family Foundation also found:
These high-risk pools likely covered just a fraction of the number of people with pre-existing conditions who lacked insurance, due in part to design features that limited enrollment. State pools typically excluded coverage of services associated with pre-existing conditions for a period of time and charged premiums substantially in excess of what a typical person would pay in the non-group market. PCIP had fewer barriers to enrollment – charging standard premiums with no pre-existing condition exclusions – but it did restrict signups to people who had been uninsured for a least six months.
Even with these limitations, the government subsidies required to cover losses in these high-risk pools were substantial – over $1 billion per year in the state pools and about $2 billion in the final year of [federal pre-existing insurance fund].
In short they run out of money. Ryan’s scheme does nothing to guarantee that the federal government will keep the plans operational.
Ryan wouldn’t concede that it is only a theory that insurance premium prices would come down under his plan. In fact, because his bill does not change the minimum required benefits or make any other regulatory changes it is highly unlikely that prices will decrease. Ryan seems blissfully unaware that his plan will accelerate the death spiral, fail to reduce prices and leave millions of people who want insurance without affordable plans.
Ryan seems to have entirely lost his way. He now thinks that “the most important thing for a person like myself, who runs for office and tells the people we are asking to hire us, this is what I will do if I get elected. And then, if you don’t do that, you are breaking your word.” What if the promise you made was ill-informed, impossible or dumb? Your obligation must be to govern wisely, not stick to foolish promises. This sounds like someone frantic to rush through a bill more flawed than Obamacare, only to say he did what he promised.
Republican have demonstrated more clearly than ever that they have not thought this through. Their half-baked arguments and dismissive tone reveal they lack the skills to govern smartly. In dismissing coverage numbers they sound cruel and out of touch.
The Senate, presumably, will derail the House’s monstrosity — if it gets that far. As for Ryan, his reputation as the party’s chief wonk is badly eroded. Transparent and effective governance based on an honest assessment of the facts does not seem to be his strength.