The American Health Care Act is basically a straightforward welfare-state rollback. That’s why the conservative movement supports it. Conservatives think the government spends too much money on income-transfer payments. AHCA would eliminate just over $1.1 trillion ($834 billion in Medicaid, plus another $276 billion in tax credits) in subsidies for health care for the poor and middle class. The trade-off for those cuts is the opportunity to finance a large, regressive tax cut. Spending way less to help people afford health insurance means those people wouldn’t be able to afford health insurance. That’s why the uninsured rate declined by 20 million since Obamacare started, and why it would go back up by about the same if AHCA gets passed.
At his press conference today, Paul Ryan insisted that access to affordable health coverage for one and all is truly his goal:
What do we want? What do we all want? We want everybody who doesn’t get health care from either Medicare or Medicaid or from their job, about 11% of Americans, we want them, too, to get access to affordable health care.
There is all kinds of sophistry and distortion in Ryan’s remarks. He argued that, by freeing up states to “innovate,” his bill would somehow lead them to fund high-risk pools to cover the costs of people with expensive conditions. He did not explain why the states would somehow pony up this money when they were free from Obamacare regulatory burdens for decades leading up to 2014 and did no such thing. There is zero reason to believe that letting states go back to the deregulated insurance markets that prevailed before Obamacare would have any different result.
If Ryan was honest, he would admit he thinks that’s fine. He doesn’t like taxes, spending, or regulation, and he thinks going back to the pre-Obamacare system would be better for that reason. Instead he smarmily insists his plan would do that while also making health care affordable to everybody. Whatever design he decides to use for the health-care system, cutting a trillion dollars from health-care subsidies in order to reduce taxes is going to deprive a lot of people of their coverage. This is the core effect of his plan, and he won’t fess up to it at all. Ryan is a Social Darwinist without the courage of his convictions.