“The CBO is consistently inconsistent,” Sen. Tim Scott (R-SC) told TPM. “They can’t predict the actual results of a 10-year window, because life changes so quickly. So I don’t put that much weight on a CBO score.”
Over on the House side, Rep. David Brat (R-VA) laughed when TPM asked about the rush to mark up the bill without knowing its cost or impact. “The CBO, they’ve scored everything wrong for decades,” he said.
.. Asked whose report he would rely on if not that of the non-partisan office, Thompson replied, “Trust me, this bill will be subject to all kinds of alternative analysis.”
.. Standard & Poor’s estimated that 2-4 million people would drop out of the individual insurance market due to rising premium costs, and that another 4-6 million would lose their Medicaid coverage. The Brookings Institution estimates that as many as 15 million people could lose coverage, largely because the repeal of the individual mandate would drive up costs for those who remain insured.
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.
The Republican Health Care Crackup
By 2010, however, both the Obama administration and the Tea Party opposition were out of step with the times. They both still thought the big political issues in American life were universal health care and the size of government.
.. In fact, another set of problems had magnified and come to overshadow the old set. This new set included:
First, the crisis of opportunity. People with fewer skills were seeing their wages stagnate, the labor markets evaporate. Second, the crisis of solidarity. The social fabric, especially for those without a college degree, was disintegrating — marriage rates plummeting, opiate abuse rates rising. Third, the crisis of authority. Distrust in major institutions crossed some sort of threshold. People had so lost trust in government, the media, the leadership class in general, that they were willing to abandon truth and decorum and embrace authoritarian thuggery to blow it all up.
.. If President Obama had made these crises the center of his administration, instead of the A.C.A., Democrats wouldn’t have lost Congress and the White House. If the Tea Party had understood the first two of these crises, there would have been no opening for Donald Trump.
.. he has no positive agenda for addressing them. He can tap into working class anxiety negatively, by harnessing hostility toward immigrants, foreigners and the poor. But he can’t come up with a positive agenda to make working class life more secure.
.. a group of Freedom Caucus Republicans who still think the major problems in the country today can be cured with tax and spending cuts. We have a Trump administration that has populist impulses but no actual populist safety net policies. And we’ve got a Republican leadership in Congress mired in Reagan-era thinking
.. The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail. The penalties for those who don’t purchase insurance are so low they seem sure to guarantee Republican-caused death spirals in the weaker markets.
.. But now you’ve got millions of people growing up in social and cultural chaos and not getting the skills they need to thrive in a technological society. This is not a problem you can solve with tax cuts.
.. voters around the world have demonstrated that they’re quite willing to destroy market mechanisms to get the security they crave. They will trash free trade, cut legal skilled immigration, attack modern finance and choose state-run corporatism over dynamic free market capitalism.
.. If you are pro-market, you have to be pro-state. You can come up with innovative ways to deliver state services, like affordable health care, but you can’t just leave people on their own.
Paul Ryan’s Health-Care Vise
As with the majority of House Republicans, most members of the Freedom Caucus have only ever served under a Democratic President. They were elected to oppose Obama and everything he stood for and they spent most of his Presidency attacking Republican leaders who they believed thwarted those efforts. They have no experience legislating.
.. An early version of the Ryan plan replaced these subsidies with less generous refundable tax credits, which many conservatives dislike because Americans who pay no taxes would still be eligible for the credits.
.. Ryan’s response was to leave the expansion in place until 2020
.. Proponents of the Medicaid expansion see the deadline as creating a health-insurance time bomb that will detonate in a few years.
.. Health-care reform has long been stymied by the insurance industry. Bill and Hillary Clinton took on the industry in 1994 and were badly defeated. In 2009, Obama decided to buy the industry off by including a provision forcing every American to buy its product—the dreaded individual mandate.
.. Ryan and Trump have insisted they would keep those popular regulations while killing the mandate, which forces the uninsured to pay a tax penalty. Their solution is that the uninsured would pay a penalty to insurance companies. Specifically, insurers would be allowed to charge anyone with a two-month gap in coverage up to a thirty-per-cent surcharge on a new policy. For many Americans, the surcharge in Trumpcare could end up being more than the current tax penalty in Obamacare.
.. When Lyndon Johnson created Medicare he essentially made up and lowballed the long-term costs of the program. Without a true estimate, it was difficult for fiscal conservatives, medical groups, and other opponents to attack the plan, and it sailed through Congress.
.. In 2009, Obama became so frustrated by the C.B.O., whose cost estimates had an enormous impact on the health-care debate, that during an Oval Office meeting he said he didn’t want to hear the C.B.O. mentioned, so his aides referred to it as “banana.”
.. Ryan needed to shape a bill that would survive this process, and as a result, he left out some of conservatives’ most long-standing health-care-policy ideas. (For instance, most conservatives support changing a law that prevents insurance from being sold across state lines, arguing it would make markets more competitive and bring down costs, but Ryan didn’t include the change in his plan.)
.. Ryan has produced a bill that nobody would ever propose as a sane solution to the problems with Obamacare. Its only chance is speed. If Ryan can rush and muscle it through the House and Mitch McConnell can do the same in the Senate, it might end up on Trump’s desk. But the more scrutiny this House bill is subject to, the more likely it is to share the fate of most efforts at health-care reform and die somewhere on its journey to the Senate