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Hullabaloo


Tuesday, March 14, 2017

 

No room for people

by Tom Sullivan


What's missing from the Trump-Ryan health care plan is people.

Numbers, numbers, numbers. House Speaker Paul Ryan loves numbers. And freedom. People? Not so much.

The Congressional Budget Office (CBO) analysis of the American Health Care Act (AHCA) concludes (emphasis mine):
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026. The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
That is, more Americans will lose coverage than received it under the Affordable Care Act. Americans will be worse off than if Obama's Affordable Care Act was never passed. As much as the White House has worked in recent days to undermine the expected bad press about the Republican replacement bill from the CBO, Politico reports that a White House estimate is even bleaker. That estimate of Americans losing coverage is 26 million:
White House officials late Monday night disputed that the document is an analysis of the bill’s coverage effects. Instead, they say it was an attempt by the Office of Management and Budget to predict what CBO’s scorekeepers would conclude about the GOP repeal plan.
Big BUT, says Paul Ryan, premiums will come down 10 percent for those who are left. The Wisconsin Republican tells Fox News:
"Of course they’re going to say if we stop forcing people to buy something they don’t want to buy they’re not going to buy it," Ryan said. "That’s why you have these uninsured numbers, which we all expected."

According to Ryan, the key numbers in the analysis would come once the bill's reforms took effect in 2020.

"It will lower premiums 10 percent. It stabilizes the market. It’s a $1.2 trillion spending cut, and $883 billion tax cut and $337 billion in deficit reduction," Ryan said. "So, this compared to the status quo is far better."
Ryan forgot to mention the CBO projects that cutting funding to Planned Parenthood for a year would result in "several thousand" additional births which, if they are the right kind of babies, will make Iowa Rep. Steve King happy.

Slate's Jonathan Weissmann writes of the CBO analysis analysis:

There are lots of losers under the Republican plan to replace Obamacare, but perhaps nobody would suffer as badly as older Americans who live just above or around the poverty line. According to the new estimates from the Congressional Budget Office, that group could see its insurance premiums rise by 750 percent within a decade years under the House GOP's American Health Care Act, compared to what they'd pay under current law for more comprehensive coverage.
That's not a typo, he repeats: 750 percent.

There will be a lot of numbers bandied about as Republicans and the Trump White House try to control the narrative surrounding the AHCA. Ryan argues that the CBO scoring fails to take into account that this is only Phase 1 of the GOP's three phase plan for repealing and replacing Obamacare. The twin miracles of choice and competition don't kick in until later, Market willing.

What's lost among the political abstractions and ideology is people. The numbers leave little room for human beings seeing a doctor when they get sick. But freedom, ya know? And deficit reduction. And corporate tax cuts. "Far better" for treating your child's cancer, or your own. Believe him. But maybe a little more detail is needed in Phase 2.