CBO report roils Ryancare debate
House Republicans were struggling to rally congressional support for their proposal to replace the Affordable Care Act this week, after a highly anticipated report by the Congressional Budget Office (CBO) predicted that the bill would cause the number of Americans without health insurance to grow by 24 million by 2026. The proposed legislation, the American Health Care Act, would scrap the individual mandate, which imposes tax penalties on those who don’t have insurance; replace income-based premium subsidies with smaller tax credits linked to age; and reverse Obamacare’s Medicaid expansion. The CBO, a nonpartisan group currently led by a Republicanpicked appointee, estimated that this plan would lead to 14 million more uninsured Americans after the first year, and another 10 million after caps on Medicaid funding go into effect in 2020. The bill would reduce the deficit by $337 billion over the next decade, the CBO projected, and premiums would shrink to 10 percent below what they would be under Obamacare by 2026—but only after jumping 15 percent to 20 percent over the next two years. The analysis concluded that older, low-income Americans buying insurance on the individual market would pay “substantially more” for health care than they do now.
The CBO report created turmoil among Republicans, with Sen. Tom Cotton (R-Ark.) saying that if Republicans “vote for this bill they’re going to put the House majority at risk next year.” House Speaker Paul Ryan, the primary author of the health-care plan, insisted that a reduction in the number of insured would be mostly voluntary. “Our plan is not about forcing people to buy expensive, one-size-fits-all coverage,” Ryan said. But at least a dozen GOP senators raised concerns over Ryancare’s impact on seniors and Medicaid recipients in their states and said the bill would need to be altered. More-conservative lawmakers said the bill didn’t go far enough in reducing government subsidies for health-care coverage. “There’s not really any kind of coalition that’s going to get the Ryan bill to pass,” said Sen. Rand Paul of Kentucky.
President Trump continued to express support for the bill, but talked this week with GOP leaders about potential revisions. Ryan was counting on the president to pressure House members to fall in line behind his proposal—which Trump has yet to decide to do.
What the editorials said
“So much for President Trump’s pledge of ‘insurance for everybody,’” said The New York Times. Ryancare would “produce an enormous amount of human misery” by throwing millions of Americans off their health coverage; raising deductibles for everyone; and shifting costs from younger, healthier people, who would no longer have to buy insurance, to seniors. Why are Republicans pushing it? Simple: The law would scrap $600 billion in taxes that pay for Obamacare’s subsidies, giving “a gigantic tax cut to wealthy Americans.”
There’s good news in the CBO report, particularly the deficit reduction of $337 billion, said The Wall Street Journal. The report suggests most of the “initial coverage plunge” of 14 million would be the result of freeing Americans from the individual mandate, so they could choose not to buy insurance. Besides, “CBO models are not a writ carved in stone by a finger of light.” They wildly overestimated the number of original Obamacare enrollees, and often discount the effect of market forces. The GOP should “have confidence that their ideas will work, and march ahead.”
What the columnists said
Ryan is stuck between two “diametrically opposed” GOP factions, said Andrew Prokop in Vox.com. On one side is the hard-line conservative House Freedom Caucus, which thinks the bill “fails to roll back enough of Obamacare.” On the other is a disparate group of lawmakers who fear the reforms will cause too many people to lose coverage. The “Coverage Caucus” is just as capable of scuttling the bill as the Freedom Caucus—and Ryan can’t please one without infuriating the other.
To make this bill less “politically poisonous,” Republicans simply have to “get the coverage numbers up,” said Rich Lowry in NationalReview.com. They could easily allocate more money to make the tax credit “more generous further down the income scale.” Arguing that the “people don’t need health insurance” sounds like stereotypical Republican heartlessness—and will backfire badly. Republicans might be better off passing nothing, said Megan McArdle in BloombergView.com. If they force the Ryan bill through without any Democratic votes, they’ll end up with “100 percent of the blame” for everything people dislike about the health-care system. Far better to wait for Obamacare’s exchanges to fully collapse, and then enact a comprehensive conservative overhaul.
Why is President Trump backing this bill? asked Byron York in Washington Examiner.com. He was elected to bring back and create jobs, cut taxes and regulations, and put a jolt into the economy. But he’s allowing House Republicans to drag him into “a complex, time-consuming, and unpopular fight” over an issue that isn’t a priority for most voters. “Republicans are working on the wrong thing,” and if Trump lets them set his agenda, he may end up burning through much of his political capital with little reward.
Illustration by Fred Harper. Cover photos from Newscom, Getty, AP