can this legislation still go through? I have learned never to underestimate the cravenness of Republican “moderates,” who may posture to the center but almost always cave to the hard right when it matters. But even so, it’s hard to imagine this act of cruelty getting 50 senators.
A Plan Set Up To Fail
Roughly speaking, 20 million Americans gained coverage at a cost of around 0.6 percent of GDP.
.. Taken together, these moves would almost surely lead to a death spiral. Healthy individuals, especially low-income households no longer receiving adequate aid, would opt out, worsening the risk pool. Premiums would soar – without the cushion created by the current, price-linked subsidy formula — leading more healthy people to exit. In much of the country, the individual markets would probably collapse.
The House leadership seems to realize all of this; that’s why it reportedly plans to rush the bill through committee before CBO even gets a chance to score it.
Paul Krugman: Paul Ryan is a Con Artist who started to believe his own con
But has Ryan ever put together major legislation with any real chance of passage? Yes, he made a name for himself with big budget proposals that received adoring press coverage. But these were never remotely operational — they were filled not just with magic asterisks — tax loophole closing to be determined later, cost savings to be achieved via means to be determined later — but with elements, like converting Medicare into a voucher system, that would have drawn immense flack if they got anywhere close to actually happening.
In other words, he has never offered real plans for overhauling social insurance, just things that sound like plans but are basically just advertisements for some imaginary plan that might eventually be produced. Actually pulling together a coalition to get stuff done? Has he ever managed that?
What I’d say is that Ryan is not, in fact, a policy entrepreneur. He’s just a self-promoter, someone who has successfully sold a credulous media on a character he plays: Paul Ryan, Serious, Honest Conservative Policy Wonk. This is really his first test at real policymaking, which is a very different process.
.. Everything else about the AHCA looks slapdash, like something thrown together in a few days by people who hadn’t thought at all about what a flat tax credit and a widened age band would mean for, say, people in Alaska with its expensive insurance, or low-middle-income Trump voters in their 60s. I have no inside information, but this sure looks as if they were still dithering about the whole principle of their Obamacare replacement until at most a few weeks ago, and didn’t work with CBO because they had nothing to work with.
.. In other words, maybe this looks like amateur hour because it is. Ryan isn’t a skilled politician inexplicably losing his touch, he’s a con artist who started to believe his own con
A Bill So Bad It’s Awesome
Given the rhetoric Republicans have used over the past seven years to attack health reform, you might have expected them to do away with the whole structure of the Affordable Care Act — deregulate, de-subsidize and let the magic of the free market do its thing. This would have been devastating for the 20 million Americans who gained coverage thanks to the act, but at least it would have been ideologically consistent.
.. with some justice, calling Obamacare 2.0. But a better designation would be Obamacare 0.5, because it’s a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions. If enacted, the bill would almost surely lead to a death spiral of soaring premiums and collapsing coverage.
Obamacare rests on three main pillars.
- Insurance companies are regulated, prevented from denying coverage or charging higher prices to Americans with pre-existing conditions.
- Families receive subsidies linked to both income and premiums, to help them buy insurance.
- And there is a penalty for those who don’t buy insurance, to induce people to sign up even if they’re currently healthy.
.. a 55-year-old making $25,000 a year would end up paying $3,600 a year more for coverage; that rises to $8,400 for a 64-year-old making $15,000 a year. And that’s before the death spiral.
.. Republicans have been claiming that Obamacare is collapsing, which isn’t true. But Trumpcare, if implemented, would collapse in a Mar-a-Lago minute.
- .. There are real conservative policy experts, but the party doesn’t want them, perhaps because their very competence makes them ideologically unreliable — a proposition illustrated by the rush to enact this bill before the nonpartisan Congressional Budget Office can estimate either its costs or its effects. Basically, facts and serious analysis are the modern right’s enemies;
- .. Second, Republicans seem to have been undone by their reverse-Robin-Hood urges.