I have rarely seen a document in politics as completely devastating as the analysis
the Congressional Budget Office just released of the Republican health care bill.
We’re going to get into details in a minute, but here’s a one-sentence summary: Under
the GOP bill, the more help you need, the less you get.
It will make more people uninsured than live in New York state.
And those raw numbers, those headline numbers, they actually obscure how cruel the underlying
policy is.
It is particularly bad for the old and the sick and the poor.
It is particularly good for the rich and the young and the healthy.
And to understand why, you have to go into the specifics of what the bill does.
So here’s how it works.
The bill guts Medicaid, it cuts the value of Obamacare’s insurance subsidies in half,
and it lets insurance companies charge older Americans 500 percent more than they charge
younger Americans.
Then it takes the subsidies that are left and reworks them to be worth less to the poor
and less to the old.
It takes the insurers that are left in the market and it gives them the ability to change
their plans, their plans to cover fewer medical expenses for the sick.
And then finally it rewrites the tax code to offer hundreds of billions of dollars in
tax cuts to the rich.
As my colleague Dylan Matthews wrote, it is an act of incredible class warfare by the
rich against the poor.
Imagine the set of questions you would have had to ask to get a bill like this.
Who is sitting back and saying, what American health care needs is more uninsured people,
coverage that doesn’t cover as much, coverage that is higher deductibles, more power for
insurers to charge old people more money than young people, and finally, hundreds of billions
of dollars in tax cuts for the rich.
Is that the populism Donald Trump ran on?
Is that what any Republican’s seen at polls even of their own voters?
Because I have looked at those polls.
And even Republican voters, they actually want better health care that is more affordable
to them and that actually does cover when they get sick.
The result of all this isn’t just 24 million fewer people with insurance: Of the people
that are left with insurance, the pool is tilted toward younger, healthier people who
needed help less, because many of the older, poorer, sicker people who needed help the
most have been driven out of the market.
They don’t have insurance they can actually afford.
The example that keeps getting me: A 64-year-old making $26,500, somebody who very well might
have voted for Donald Trump, would see his premiums rise by 750 percent.
And now that 64-year-old gone, no insurance, but because he’s gone, the pool is a little
bit younger, and so the premiums for the young people left are a little bit cheaper.
That is the context that is required to read Speaker Paul Ryan’s response to the report.
He tweeted — and this was the most amazing part of the whole thing for me — he tweeted:
“CBO report confirms it, American Health Care Act will lower premiums & improve access
to quality, affordable care.”
Let’s break that down.
So according to the Congressional Budget Office, the lower premiums Ryan is celebrating (those
premiums, to be sure, they’re only 10 percent lower after 10 years, and that’s after they
rise initially) — those lower premiums, the reason you get them, his bill drove older
people out of the market, it let insurers offer plans that covered fewer medical expenses
and required more out-of-pocket spending.
That is not “lower premiums” as most Americans understand the term.
Getting lower premiums by cutting out the people who needed help the most?
That's not what health care's supposed to do.
We have health insurance because people get sick, because they need it.
But it is Ryan’s last five words that demand the most attention.
He says his bill will “improve access to quality, affordable care.”
I am trying to find a way to read this statement generously.
Ryan is not arguing with the CBO score here.
This is what I can’t believe.
He is not saying the CBO is wrong and more people will be covered under his bill.
He is saying the CBO is right, its analysis proves his bill will improve access to quality,
affordable care.
He is saying that a bill that throws 24 million people off insurance is a bill that improves
access to quality, affordable care.
Look, I am schooled in health policy wonk rhetoric.
I know what is being said here.
I know that “improves access” is some kind of dodge, ’cause you can have access
to affordable health insurance even if you choose not to buy it — but a bill that makes
health insurance too expensive for millions to afford doesn’t improve access under any
definition of the word.
A bill that makes the insurance not worth buying, it doesn’t improve access, it doesn’t
improve choice.
And look, maybe I’m overthinking this.
Maybe Ryan did not know what his bill will do, and he is now stuck defending it because
it’s his bill, and he sees no other choice.
Maybe he has become the “This is fine” dog, cheerfully explaining away the fire raging
around him, a fire he himself has set.
But this is not fine.
It is not decent, it is not compassionate, and it is not what Republicans promised.
It is a betrayal of Donald Trump’s vow to protect Medicaid from cuts.
It’s a betrayal of Donald Trump’s vow to pass a health care bill that covers everyone
with insurance that has lower deductibles and better coverage.
It is a betrayal of Paul Ryan’s promise to give Americans more choices, because it
is only when you can afford insurance that you really have the choice of which plan to
buy.
And it is a betrayal of the older, rural voters who put Republicans in power and who will
pay the most for health insurance under this proposal.
It is hard to imagine the electoral reckoning that would follow the implementation of this
law.
But that’s the thing about setting a fire.
You’re often the one who gets burned.