“OBAMACARE IS not going to last,” House Speaker Paul D. Ryan (R-Wis.) said Sunday when challenged to explain how he could support a replacement plan that independent experts project would result in millions of people losing health coverage. “There’s no way Obamacare could stick another two or three years, let alone 10 years.”
This is the last rhetorical refuge for defenders of a shoddy GOP replacement plan: Practically any system would be better than the “collapsing” status quo. “Five states have one plan left, over a third of the counties in America have only one insurer left,” Mr. Ryan explained on “Fox News Sunday.” “Some are already pulling out, massive premium increases in the future.”
Yet a wide swath of independent experts see no real disaster. Just look at the big picture in today’s Obamacare marketplaces, says the Kaiser Family Foundation’s Larry Levitt: “Marketplace enrollment has largely held steady,” he wrote us in an email. “Also, enrollment trended slightly older, but not by a meaningful amount and certainly nothing to suggest that it’s spiraling out of control.” And that is with a hostile new administration undermining enrollment this year.
The Congressional Budget Office, meanwhile, projected last week that “the nongroup market” — that is, the section of the health-care industry that Obamacare focuses on — “would probably be stable in most areas” under current law. The CBO found the same for Mr. Ryan’s bill. Both plans would see “insurers participating in most areas of the country.”
It is true that “stable” does not mean “perfect.” Some areas of the country, especially sparsely populated, rural regions that have been historically difficult to cover, might continue to have trouble attracting insurers. But some areas of the country would almost certainly struggle to attract insurers under the GOP plan, too, because the tax credits it would give people to buy insurance would be small relative to the price of care in expensive regions. The CBO’s bottom line remains: Under neither Obamacare nor the GOP alternative would there be a catastrophic nationwide death spiral.
There are crucial differences in how each plan would achieve market stability. Obamacare’s subsidy system scales according to income, premium and region, enabling needy insurance buyers — people who are older or sicker or live in a more expensive state — to buy decent-quality plans. The CBO predicted that, combined with the individual mandate, these provisions would keep the number of uninsured about flat, following unprecedented coverage gains in previous years, and, by law, all of those enrollees would have good coverage.
By contrast, the Republican bill would slash subsidy spending and loosen regulations. Though the system might benefit some younger insurance buyers, coaxing more of them into the market, it would also make it much harder for, say, a 60-year-old in a rural county to afford insurance. Insurers certainly would not reach for their business. Fewer people who really need coverage would get it, and the coverage people bought would be skimpier. The plan would save the treasury some money, but not nearly enough to justify the human misery that would result from coverage losses concentrated among the low-income and the aging.
Though Republicans say they will change the bill to become more generous, they have nevertheless painted a fictional account of total policy disaster in order to make their plan look good.