The GOP health care plan: The more you need, the less you get

I have rarely seen a document in politics
as completely devastating as the analysis the Congressional Budget Office just released
of the Republican health care bill. We’re going to get into details in a minute,
but here’s a one-sentence summary: Under the GOP bill, the more help you need, the
less you get. It will make more people uninsured than live
in New York state. And those raw numbers, those headline numbers,
they actually obscure how cruel the underlying policy is. It is particularly bad for the old and the
sick and the poor. It is particularly good for the rich and the
young and the healthy. And to understand why, you have to go into
the specifics of what the bill does. So here’s how it works. The bill guts Medicaid, it cuts the value
of Obamacare’s insurance subsidies in half, and it lets insurance companies charge older
Americans 500 percent more than they charge younger Americans. Then it takes the subsidies that are left
and reworks them to be worth less to the poor and less to the old. It takes the insurers that are left in the
market and it gives them the ability to change their plans, their plans to cover fewer medical
expenses for the sick. And then finally it rewrites the tax code
to offer hundreds of billions of dollars in tax cuts to the rich. As my colleague Dylan Matthews wrote, it is
an act of incredible class warfare by the rich against the poor. Imagine the set of questions you would have
had to ask to get a bill like this. Who is sitting back and saying, what American
health care needs is more uninsured people, coverage that doesn’t cover as much, coverage
that is higher deductibles, more power for insurers to charge old people more money than
young people, and finally, hundreds of billions of dollars in tax cuts for the rich. Is that the populism Donald Trump ran on? Is that what any Republican’s seen at polls
even of their own voters? Because I have looked at those polls. And even Republican voters, they actually
want better health care that is more affordable to them and that actually does cover when
they get sick. The result of all this isn’t just 24 million
fewer people with insurance: Of the people that are left with insurance, the pool is
tilted toward younger, healthier people who needed help less, because many of the older,
poorer, sicker people who needed help the most have been driven out of the market. They don’t have insurance they can actually
afford. The example that keeps getting me: A 64-year-old
making $26,500, somebody who very well might have voted for Donald Trump, would see his
premiums rise by 750 percent. And now that 64-year-old gone, no insurance,
but because he’s gone, the pool is a little bit younger, and so the premiums for the young
people left are a little bit cheaper. That is the context that is required to read
Speaker Paul Ryan’s response to the report. He tweeted — and this was the most amazing
part of the whole thing for me — he tweeted: “CBO report confirms it, American Health
Care Act will lower premiums & improve access to quality, affordable care.” Let’s break that down. So according to the Congressional Budget Office,
the lower premiums Ryan is celebrating (those premiums, to be sure, they’re only 10 percent
lower after 10 years, and that’s after they rise initially) — those lower premiums,
the reason you get them, his bill drove older people out of the market, it let insurers
offer plans that covered fewer medical expenses and required more out-of-pocket spending. That is not “lower premiums” as most Americans
understand the term. Getting lower premiums by cutting out the
people who needed help the most? That’s not what health care’s supposed to
do. We have health insurance because people get
sick, because they need it. But it is Ryan’s last five words that demand
the most attention. He says his bill will “improve access to
quality, affordable care.” I am trying to find a way to read this statement
generously. Ryan is not arguing with the CBO score here. This is what I can’t believe. He is not saying the CBO is wrong and more
people will be covered under his bill. He is saying the CBO is right, its analysis
proves his bill will improve access to quality, affordable care. He is saying that a bill that throws 24 million
people off insurance is a bill that improves access to quality, affordable care. Look, I am schooled in health policy wonk
rhetoric. I know what is being said here. I know that “improves access” is some
kind of dodge, ’cause you can have access to affordable health insurance even if you
choose not to buy it — but a bill that makes health insurance too expensive for millions
to afford doesn’t improve access under any definition of the word. A bill that makes the insurance not worth
buying, it doesn’t improve access, it doesn’t improve choice. And look, maybe I’m overthinking this. Maybe Ryan did not know what his bill will
do, and he is now stuck defending it because it’s his bill, and he sees no other choice. Maybe he has become the “This is fine”
dog, cheerfully explaining away the fire raging around him, a fire he himself has set. But this is not fine. It is not decent, it is not compassionate,
and it is not what Republicans promised. It is a betrayal of Donald Trump’s vow to
protect Medicaid from cuts. It’s a betrayal of Donald Trump’s vow
to pass a health care bill that covers everyone with insurance that has lower deductibles
and better coverage. It is a betrayal of Paul Ryan’s promise
to give Americans more choices, because it is only when you can afford insurance that
you really have the choice of which plan to buy. And it is a betrayal of the older, rural voters
who put Republicans in power and who will pay the most for health insurance under this
proposal. It is hard to imagine the electoral reckoning
that would follow the implementation of this law. But that’s the thing about setting a fire. You’re often the one who gets burned.


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