The Washington PostDemocracy Dies in Darkness

Millions of lives are in Paul Ryan’s hands. His Catholicism is our only hope.

The House speaker's proposed cuts to health care would put children, poor people and the elderly at risk.

House Speaker Paul D. Ryan (R-Wis.) should consider what his Church has to say on health care for all before cutting down access for the most vulnerable. (Jim Loscalzo/European Pressphoto Agency)
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The groundswell of support for health-care reform (Reuters recently found that it is the topic most Americans want Donald Trump to address in his first 100 days) has led many to believe it will be the first priority of Republicans and the new administration. Indeed, Trump’s campaign manager, Kellyanne Conway, suggested that the president-elect may even push for a special session of Congress the day of his inauguration to repeal the Affordable Care Act.

But how the program is reformed is just as important as the fact that it is — especially for people of faith. And that may be largely up to House Speaker Paul D. Ryan (R-Wis.), himself a devout Catholic.

Trump has spoken positively of single-payer health care in other countries as recently as the first debate in the Republican primaries. And he has strongly hinted that he will keep many important provisions of the ACA. But as Sarah Kliff pointed out in her important piece for Vox, Trump doesn’t have anything like a proposal on the table. Conservative proposals vary widely. Which way Trump will go is, as ever, unclear.

Paul Ryan addresses media at Trump Tower (Video: The Washington Post)

New push to replace Obamacare reignites old GOP tensions

Yet if we want a hint about the direction the conservative debate will probably take, we can look at two recent pieces of news: Ryan seems much happier with Trump these days than he did during the primary; and Rep. Tom Price (R-Ga.), Trump’s pick for secretary of health and human services, could have been selected by Ryan himself. Indeed, after the announcement of Price’s nomination was made public, the speaker’s office immediately released a statement calling him “the perfect choice.” Ryan would know, having worked hand-in-glove with Price in the House to craft alternative health-care legislation. Indeed, Price’s “Empowering Patients First Act” served as the basis for Ryan’s current reform proposal. So it’s likely that the speaker and the new administration will be working together in driving the conservative debate over what will replace the ACA. What they come up with, therefore, has a serious shot at becoming law.

But Ryan’s proposal is deeply problematic — especially for the most vulnerable. And for Catholics, that’s a serious problem. Although Catholics had plenty of reasons to critique the ACA, including understandable concerns about the Obama administration’s health policy steamrolling individuals and communities who cannot in good conscience participate in abortion, the overall effort to make health care as accessible as possible is, by Catholic standards, a worthy goal.

But Ryan’s proposal only requires insurance companies to accept those with preexisting conditions if they maintain “continuous coverage.” If a cancer patient, say, had a break in her coverage at any point, she would go back to the horrific old days of having insurance companies gouge her for unaffordable premiums.

Ryan would put $25 billion into a high-risk pool to help people in her situation over the next 10 years, but this proposal probably underestimates the number of people who would be denied traditional coverage because of preexisting conditions and the incredibly high cost of such coverage. There is a good chance that, with only this amount of money allocated, the pool will be forced to exclude many people who have preexisting conditions.

And because Ryan’s plan scales back the ACA’s Medicaid expansions, about 18 million vulnerable people are likely to lose their Medicaid coverage. Estimates from the Bipartisan Policy Center show that “in the year 2022, Ryan’s spending on Medicaid and CHIP is $332 billion, whereas under [the Congressional Budget Office’s] baseline, that total amounts to $628 billion. Approximately half of this reduction results from the fact that Ryan’s budget repeals the Medicaid and CHIP expansion in the ACA, while the other half — roughly $160 billion in 2022 — is the cut produced by the block granting of both programs.” These cuts are astonishing, and will be painful for children and the elderly.

Ryan’s plan also allows insurance companies to charge older, sicker people five times more for premiums compared with charges for younger, healthier people. As Kliff points out, “[p]remiums for a 24 year-old would decline from $2,800 to $2,100 — but premiums for a 64 year-old would rise from $8500 to $10,600.”

There are understandable reasons for these proposals. Insuring all those with preexisting conditions in every circumstance adds substantial cost. Medicaid is an expensive program that will eat up an increasingly large percentage of the budget in coming decades. For programs such as Obama’s and Ryan’s to work, there simply have to be cost incentives for young, healthy people to enroll.

But this isn’t a problem with Obamacare. It is the problem with giving more power to market forces within a health-care system: They privilege those who need the help least — and hurt those who need the help most.

Ryan is a committed Catholic, and thus inspired by Christ’s command to see his face in the least among us. He is rightly concerned that health-care reform protect vulnerable prenatal children. But this commitment applies just as earnestly to the vulnerable populations hurt by his proposed policies above.

As Cardinal Timothy Dolan pointed out in the debate over the ACA, the U.S. Catholic Bishops have supported universal health care since 1919. And the church continues to insist that a Catholic commitment to health care “should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable.”

Ryan’s commitment to the Catholic Church means that he ought to rethink his health-care reform proposals and make sure that — instead of privileging the young, wealthy and healthy — they instead lift up the sick, poor and old. It is through these populations, after all, that Christ comes to us today. Indeed, Christians are told that it is how we treat them that will determine our ultimate fate after death.

We found trillions of dollars to fight unnecessary wars overseas. We are likely to find them for a huge, bipartisan infrastructure project. There is no excuse for not finding them to make sure that the least among us have the health care they are owed. To do any less means abandoning people bearing the face of Christ Himself.