March 13, 2017 Last Updated 8:36 am

Despite CBO scoring that shows 24 million may lose coverage, its full speed ahead for Speaker Ryan

Many journalists are pretty sure the CBO estimate will hurt the chances of Ryan’s bill passing the Senate, but don’t be so sure as the lure of tax cuts, and a small bite into the deficit might just be enough of a positive for some in the GOP

This should have been predictable. Despite the the Congressional Budget Office estimating that 24 million by 2026, House Speaker Paul Ryan (R-WI) issued a statement painting a rosy picture for the American Health Care Act.

“This report confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care. CBO also finds that this legislation will provide massive tax relief, dramatically reduce the deficit, and make the most fundamental entitlement reform in more than a generation. These are things we are achieving in just the first of a three-pronged approach. It’s important to note that this report does not take into consideration additional steps Congress and the Trump administration are taking that will further lower costs and increase choices.

“I recognize and appreciate concerns about making sure people have access to coverage. Under Obamacare, we have seen how government-mandated coverage does not equal access to care, and now the law is collapsing. Our plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows. And, as we have long said, there will be a stable transition so that no one has the rug pulled out from under them.

“This week, a third House committee will debate the American Health Care Act as part of an open, transparent process. We have set out a clear goal—to give every American access to quality, affordable care—and a clear plan to achieve it. Now we must keep our promise and deliver.”

The reaction was predictable because Rep. Ryan had already signaled that he saw this bill as the best chance to deliver a tax break, plus deliver a blow to socialized medicine. That the CBO said that the bill would reduce the federal deficit by $337 billion by 2026 will likely be a big sales point going forward, as well.

Many journalists immediately went on Twitter to express shock that the report looked that bad from the perspective of coverage, but those looking to kill the ACA rather than replace it might be persuaded that the $337 billion, though small compared to the economy as a whole, is a sales point they can hang their hats on.

The dirty secret of the ACA is that relatively few Americans are actually on it. The largest number estimated, used by the Obama administration at the end of last year, was 20 million. But some of those were young people under 26 who could stay on their parents insurance thanks to the new law. Others were getting Medicaid.

That is one reason why some Republicans will likely attack today’s CBO numbers has highly exaggerated. But it is also a reason why many Americans who get their health care through their employers, and who feel their rates have gone up due to the ACA, will not be all that sympathetic concerning the possible loss of coverage for many of their fellow Americans.

Just as the goal of the ACA was to insure more people, even at the possible expense of higher costs, Ryan’s bill is about tax cuts, not covering more people. Neither bill tackled the real problem with the American health care system: that it is based on employer benefits though private insurance companies. This ties health care to employment, rather than as a basic right; and it includes a middle man to pay for medical bills, the insurance companies.

Look for few to be happy with Trumpcare, like few were happy with Obamacare. The country may be letting the Republicans kick this problem down the road the way the Democrats kicked it down the road, too. In the end, this bill will be about money, who gets, and about coverage, who loses it. But while some journalists think this CBO estimate is the end of Ryan’s bill, I am not so sure. I give the bill a 50-50 chance of passing – which if I remember, is about what I thought Obamacare’s chances were, as well.


The real numbers that might kill off Trumpcare, IMO, are the rising costs for seniors.

Older Americans vote at a far higher rate than the young. Yet, rates are estimated to fall for the young and healthy, and rise dramatically for the old and ill.

Republicans will see this as simply market forces. But “insurance” is about paying for one small segment that needs coverage through the fees paid by the vast majority that don’t. That is why “insurance” is a bet, wit the better betting that they will actually lose – that is, that they will need the coverage, while the insurance company is betting that the majority will win – that they will stay healthy, or not get into a car accident, or not die.

Democrats have not been so successful at convincing the public that health care should be a basic right, like police protection. Meanwhile, Republicans have been pretty good at selling the evils of “socialized medicine.” That police protection and national security are socialized benefits gets lost in the argument.

But older Americans, not old enough to qualify for Medicare, and increasingly unable to work thanks to our nation’s obsession with hiring younger, cheaper workers, will be significantly hurt by the new health care scheme. Whether that will matter is something that is unknown right now. But Ryan is not waiting around to find out, he wants to move this bill through in a hurry. And for good reason.

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