The Republicans’ plan to roll back the welfare state without admitting they are rolling back the welfare state is producing an unremitting stream of rhetorical absurdity. Here is Paul Ryan explaining why the Congressional Budget Office’s finding, that the Senate bill increases the uninsured population by 22 million, does not really take anything away from anybody:
Ryan insists that the CBO does not show that the Republicans will take away coverage from anybody. Rather, eliminating the individual mandate will free them from having to buy something they hate: “It’s not that people are getting pushed off a plan, it’s that they will choose not to buy something they don’t like or want.”
That might be a correct analysis if CBO had found most of the coverage decrease were to occur on the exchanges. But CBO concludes that two-thirds of the people who will lose coverage will do so because of cuts to Medicaid. (Seven million fewer people will buy insurance on the exchanges, while 15 million fewer people will get it through Medicaid.) The reason for this is no mystery. The Senate plans to slash the Medicaid budget by about one-third by the tenth year:
(The cuts would accelerate after 2026, throwing even more people off their insurance, but CBO does not analyze changes that far into the future.)
The individual market would also shrink — not primarily because the individual mandate disappears, but because Republicans would cut funding for people who buy plans, rendering coverage unaffordable for millions. Here is CBO explaining that people — especially those with low incomes — won’t be able to buy insurance because the premiums and deductibles will be too high:
If you cut a trillion dollars from subsidies to help low-income people buy health insurance, then a lot of them won’t be able to afford it. That’s Ryan’s goal because he hates redistribution. But he won’t admit it’s his goal, so he spouts perfect nonsense instead.
But suppose none of this was true. Suppose Ryan was right — the GOP plan doesn’t throw people off their insurance by denying them the subsidies needed to make it affordable, it merely allows them to walk away from buying “something they don’t like or want.” Is this a good defense of the Republican bill? No, it’s an admission of total failure.
Remember, the justification for the Republican plan is that it would supposedly free Americans from unnecessary regulations and make individual health insurance attractive. This was the promise embedded in Ryan’s pablum about freedom and individual choice: “Our plan gives you more control and more choices so that you can pick the plan that meets your needs—not Washington’s mandates … Our plan gives states more flexibility so we can encourage young people to buy—and keep—insurance, helping to lower costs for everyone.” The Republicans would liberate the power of markets so that insurers sold people a product they really wanted to buy!
And now he’s saying the Republican health-care plans will be “something they don’t like or want.” This is Ryan’s own argument! And he’s saying it because it’s less awful than admitting the truth, which is that the high-deductible insurance that will be available is crappy but still too expensive for low-income people to buy, because the bill takes the money needed to make it affordable and uses it for a tax cut for wealthy investors.