At this point, the GOP is selling a health-care bill that doesn't really exist.
Republicans have in recent days taken to defending against some of the biggest criticisms of their bill using claims that are highly questionable and misleading, at best. What's notable in all of it is that the GOP isn't really even trying to sell a more conservative, limited-government approach to health care; they're pretending their bill doesn't actually reduce benefits or coverage, basically at all.
Chief among these credulity-straining claims was White House counselor Kellyanne Conway's contention Sunday that the GOP bill doesn't actually cut Medicaid. But Republicans have also suggested that the bill won't reduce the number of Americans who are insured or enrolled in Medicaid. None of these square with the reality of what the GOP is proposing.
First, here's Conway on ABCs “This Week,” when host George Stephanopoulos noted that President Trump as a candidate promised no Medicaid cuts:
These are not cuts to Medicaid, George. This slows the rate for the future and it allows governors more flexibility with Medicaid dollars because they're closest to the people in need. …
You keep calling them as cuts. But we don't see them as cuts. It's slowing the rate of growth in the future and getting Medicaid back to where it was. Obamacare expanded the pool of Medicaid recipients beyond its original intentions.
Health and Human Services Secretary Tom Price appeared on CNN's “State of the Union” and argued that the bill — the House version of which the Congressional Budget Office projected would reduce the number of Americans with insurance by 23 million over a decade — wouldn't actually force anyone to lose coverage:
What I'm telling you is that the system, the plan that we have, would put in place would not allow individuals to fall through the cracks, would not — we would not pull the rug out from under anybody. We would not have individuals lose coverage that they want for themselves and for their family.
We want to make certain that health care is available to all Americans. Right now, we have got 28 million Americans who are uninsured, who don't have insurance right now in the current plan. Is that a plan that works for patients? Absolutely not. That's the kind of thing we're trying to fix.
Sen. Patrick J. Toomey (R-Pa.) also joined in these arguments on CBS's “Face the Nation”:
I have to strongly disagree with the characterization that we're somehow ending the Medicaid expansion. In fact, quite the contrary. The Senate bill will codify and make permanent the Medicaid expansion. And, in fact, we will have the federal government pay the lion's share of the cost.
Remember, Obamacare created a new category of eligibility. Working-age, able-bodied adults with no dependents for the first time became eligible for Medicaid if their income was below 138 percent of the poverty level. We are going to continue that eligibility. No one loses coverage.
We have yet to see a CBO score for the Senate version of the health-care bill. But given that the House bill was projected to lead to 23 million fewer Americans being insured, and this bill is very similar, it's very likely we'll see a similar estimate. And even if you don't quite believe those estimates, basic logic suggests that these bills would reduce the number of Americans who are covered, simply because they would get rid of the individual coverage mandate. When you don't force people to have insurance, it's very likely fewer people will get it!
And when you throw in the CBO's estimate that the House bill would raise premiums for older, sicker Americans — sometimes exponentially — the contention that “we would not have individuals lose coverage” seems like a promise that's bound to be broken, at least to some degree.
As for the Medicaid claim, this is one that has been recycled. Price said this month that “If the baseline is today’s amount of money being spent on Medicaid, the president’s budget provides for an increase.” Basically, the GOP's argument is that, because Medicaid funding would still increase in the years to come, it's not actually cutting anything. But that completely ignores the fact that without these bills, funding would rise substantially more, as is. The CBO estimate said the House bill would reduce funding for Medicaid by more than $800 million over time. That's a cut. If your boss promises you a $10,000 bonus at the end of the year, and then she announces it's only going to be $2,000, you've had your benefits cut. That's money that was headed for your pocket until something changed.
The CBO report also said 14 million fewer people would be enrolled under Medicaid, making Toomey's “no one loses coverage” claim a real head-scratcher. Again, maybe it will be less than the CBO estimates, but saying “no one” is a very bold claim. Even if it's just 4 million, that claim will be wrong.
Look, reasonable people can disagree about how much the government should subsidize and be involved in health care. Republicans have long argued for less government involvement in this and many other arenas. And reducing the role of government in health care would logically lead to less government funding and fewer people being forced to sign up for coverage.
But that's not even the argument the GOP is making here; they're pretending their bill doesn't get rid of any of the goodies people have come to enjoy. Republicans recognize that, now that government benefits have been bestowed, taking them away is a losing political argument. So they're trying really hard, in the face of overwhelming evidence to the contrary, to pretend that's not what their bill does.