Depending on which outside analyst you ask, between 6 million and 15 million people would probably lose insurance coverage if the Republican alternative to the Affordable Care Act passes Congress and is signed into law.
Or, actually, let’s revise that. Depending on whom you ask in Republican leadership, the real number is more like zero — or, perhaps, negative: People will gain coverage under the proposal.
As part of the Republican push for the American Health Care Act, administration officials joined the Sunday political talk shows to offer their thoughts about the future of coverage. With analysis of the American Health Care Act from the nonpartisan Congressional Budget Office looming, the officials’ predictions about the effects of the bill were far rosier than the analysis offered by the Brookings Institution (15 million losing coverage over 10 years) or Standard & Poor’s (6 million to 10 million by 2024).
Here’s what they said.
Health and Human Services Secretary Tom Price: Coverage will increase. Appearing on NBC’s “Meet the Press,” Price offered his vision for what success of the bill looked like.
“Success, it’s important to look at that,” he said. “It means more people covered than are covered right now at an average cost that is less. I believe that we can firmly do that with the plan that we’ve laid out there.”
Last year, Price, then a member of the House, offered an Affordable Care Act replacement bill that was vetoed by President Barack Obama. An analysis of that bill from the Congressional Budget Office figured that 18 million people would lose coverage under that plan.
Price also told host Chuck Todd that “nobody will be worse off financially” under the proposal.
Gary Cohn, chief economic adviser to President Trump: Coverage will be maintained. On “Fox News Sunday,” Cohn was pressed by host Chris Wallace to explain whether the administration would continue to back the American Health Care Act if the Congressional Budget Office also were to predict that millions would lose coverage. He played Cohn a clip from 2015 of Trump on “60 Minutes.”
“I am going to take care of everybody,” Trump said then. “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” He repeated a similar claim shortly before his inauguration, telling The Washington Post that “[w]e’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
“Twenty million people gained coverage, have health insurance coverage now who didn’t have it before Obamacare. Are some of them going to lose coverage,” Wallace asked, “because, one, you’re going to end over a period of years the Medicaid expansion and, two, the tax credits are not going to provide as much help as the subsidies did to people who can’t afford coverage.”
“Chris, we don’t think so,” Cohn replied. “If you’re on Medicaid, you’re going to stay on Medicaid.”
“But not the expanded Medicaid,” Wallace replied.
“If you’re on Medicaid, you’re going to stay. The expansion is not going to change. There is a roll-off period, there is a period of transition, and we’re very confident that the period of transition is going to work,” Cohn said.
House Speaker Paul D. Ryan: People will make their own choices. Ryan appeared on CBS’s “Face the Nation” with John Dickerson. After Ryan (R-Wis.) offered his prediction that the Congressional Budget Office would estimate that coverage would drop, Dickerson asked how many people the speaker thought might lose coverage.
“I can’t answer that question. It’s up to people,” he said. “Here’s the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country.”
“It’s not our job to make people do something that they don’t want to do,” he added later. “It is our job to have a system where people can get universal access to affordable coverage if they choose to do so or not.”
It’s worth noting that this contrasts with what the official website for the Republican repeal effort states. Linked prominently from Ryan’s official House website, the public American Health Care Act page explicitly states in a FAQ that millions won’t lose coverage.
Budget Director Mick Mulvaney: Coverage isn’t the important thing. On ABC’s “This Week,” host George Stephanopoulos asked Mulvaney repeatedly whether Trump’s pledge to cover everybody could be upheld. Mulvaney demurred, instead insisting that the coverage itself would be more affordable. “It helps people get health care instead of just coverage,” he said.
After the pair had gone back and forth a few times, Stephanopoulos asked specifically about what would happen if the Congressional Budget Office predicted that millions of people would lose coverage. Mulvaney, like press secretary Sean Spicer last week, pointed out that the office’s estimates of coverage under the Affordable Care Act were off, predicting more coverage than was actually seen.
“If says that fewer people are going to be covered, you’ll simply reject that?” Stephanopoulos asked.
“If the CBO was right about Obamacare to begin with, there would be 8 million more people on Obamacare today than there actually are,” Mulvaney replied. “I love the folks at the CBO. They work really hard. They do. But sometimes we ask them to do things they’re not capable of doing, and estimating the impact of a bill of this size probably isn’t the best use of their time.”
“It sounds like you’ll reject it,” Stephanopoulos said, inadvertently summarizing more than just Mulvaney’s response.