Perhaps the biggest problem with Republicans' Obamacare replacement effort is that the law already exists. Whatever its warts, 20 million Americans have become insured, and that number is very likely to decline under the GOP's proposal.
Which puts the GOP in the uneasy position of arguing that this fact isn't terribly important — or at least that the impending drop in the insurance rate is overstated. The looming Congressional Budget Office estimate will probably show millions fewer having insurance under the GOP's plan, and some Republicans have already said that's a dealbreaker — enough to kill the bill in the Senate.
Enter Rep. Paul D. Ryan. The House speaker appeared on Hugh Hewitt's radio show Friday morning, and Hewitt, also a Washington Post op-ed contributor, teed up this question. Ryan's response: That the CBO report is just a “beauty contest” — a “pretty piece of paper.”
Here's the exchange (emphasis added)
HEWITT: Finally, the CBO’s going to come out with a number, Speaker Ryan, that says 15 million people are going to lose their insurance. Now you can’t really lose what you don’t use, and can’t use. How are you going to combat that number to get through the narrow gate of 51 senators?
RYAN: That’s right. I’ve been telling our members, “Just get ready.” This is always what happens with CBO. We couldn't, you know — we often mark up bills in what we call authorizing committees like Ways and Means and Commerce before you have a score, and then the score comes. That's very typical.
But we always know you’re never going to win a coverage beauty contest when it's free market versus government mandates. If the government says thou shall buy our health insurance, the government estimates are going to say people will comply and it will happen. And when you replace that with we’re going to have a free market, and you buy what you want to buy, they’re going to say not nearly as many people are going to do that. That’s just going to happen.
And so you’ll have those coverage estimates. We assume that’s going to happen. That’s not our goal. Our goal is not to show a pretty piece of paper that says we’re mandating great things for Americans. Our goal is to get a vibrant health-care system that’s patient-centered, that brings down costs, that increases choices, that has a marketplace so that we lower the costs and increase, and therefore increase the access to affordable care. That’s our goal, and it’s not to win some coverage beauty contest.
But you’re right: You’re going to see some number coming out; I have no doubt in my mind about that. I’ve spoken to our members about that. We’re going to talk to our members constantly about this, because we’re not going to get into a bidding war with the left about how much we can mandate or put entitlements out there for people. If you’re repealing one entitlement and bloc-granting to the states another entitlement, the government’s not going to say we’re getting more entitlements. It’s just simple. But that is going to be, I think, something a little bit confusing to people. And we’ve been telling our members all along you know that’s what’s going to happen, so get ready.
Ryan's comments are starting to make the rounds. Some have cast it as him saying the insurance rate itself is just a “beauty contest,” but that's not exactly correct. Ryan is arguing that the CBO estimate is the “pretty piece of paper” and that it won't tell the full story — that the GOP's plan will create such a good system that, even without the individual mandate, more people will sign up than the CBO estimates. He's basically saying that the CBO can't account for the benefits of the free market.
But this is also illustrative of the problem the GOP faces. A declining insurance rate appears to be a very likely outcome of this process, even if it's not as much as the CBO ultimately estimates. And whatever decline exists is going to be laid at Republicans' feet — an easy talking point for Democrats.
Republicans like Ryan in their heart of hearts truly believe a more free market-centered approach to health care will lead to better care and a better overall system, but that's much more difficult to quantify than “millions will lose insurance” or “millions lost insurance.” And arguing that this fact isn't important is a slippery slope toward saying something that comes across as insensitive — as freshman Rep. Roger Marshall (R-Kan.) is finding out right now.
Democrats will undoubtedly seize upon Ryan's metaphor here. The big question is whether Republicans can sell a decline in the insured rate over the long haul — especially after the bill passes and the decline is no longer an estimate, but a reality.