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Opinion: 24 million to lose health insurance, and Paul Ryan grins


In the wake of a report by the Congressional Budget Office that 24 million Americans would lose health insurance because of the GOP’s proposed Obamacare replacement plan, House Speaker Paul Ryan went on Fox News Monday night to celebrate.

“I’m pretty encouraged by it, and it actually exceeded my expectations,” a grinning Ryan said.

Fox anchor Bret Baier reacted in disbelief. If that encourages you, what kind of CBO report would discourage you? Baier asked.

“What CBO did is validate (our approach),” Ryan said, his grin growing broader. “We are block-granting Medicaid back to the states, saving $880 billion right there. This is an $880 billion tax cut for families and small businesses that help lower their health-care costs, and it reduces the deficit.”

Let’s take a minute to dissect that, because it tells you an awful lot about the value systems driving this debate.

As Ryan mentions, the $880 billion in proposed Medicaid cuts over the next decade is almost exactly equal to the $880 billion in proposed tax cuts over the same 10 years. The Medicaid cuts make the tax cuts possible. Ryan is excited about that fact. He likes it. He’s not the least bit bothered by the CBO’s projection that the Medicaid cuts alone will strip insurance from 17 million of our fellow Americans who have no other source of coverage — senior citizens in nursing homes, children living in poverty, etc.

Nor does Ryan mention that most of that $880 billion tax cut would go to wealthy Americans. According to the nonpartisan Tax Policy Center, middle-income Americans would see a tax cut that averages $300. The top 1 percent — those making $772,000 or more — would see their after-tax income jump by $37,240. The top 0.1 percent — those with incomes of $3.95 million and above — would reap an additional $207,390 on average.

Overall, the top 1 percent would collect more from the tax cuts than the bottom 80 percent combined, while many in that bottom 80 percent would see their access to health care coverage disappear. So much for President Trump’s promised war on the economic elites on behalf of the common American.

In that light, it’s fascinating to see how differently those in the Trump administration are approaching the CBO numbers. While Ryan is enthused and excited, Health and Human Services Secretary Tom Price insists they’re “just not believable” and “virtually impossible.” (It’s worth noting that in his former role as House Budget Committee chair, Price helped to handpick conservative economist Keith Hall, the CBO director who led the drafting of this report.)

However, private-industry assessments of the proposed bill have produced numbers much like those of the CBO. A secret White House assessment leaked to Politico predicts 26 million more uninsured as a result of the bill, even more than the 24 million in the CBO report. And even if you set aside such detailed analysis, simple, basic math tells you that you cannot cut a total of $1.2 trillion from Medicaid and insurance subsidies without producing significant, painful reductions in coverage.

But if you want to know what’s really going on, consider this:

Two years ago, the CBO was asked to predict the impact of a straight repeal of Obamacare, with no plan to replace it. In that 2015 assessment, CBO projected that 24 million Americans would lose coverage. Put another way, this “replacement plan” produces exactly the same coverage result as no plan at all. It is, in short, a work of mortuary cosmetology, a little dab of legislative rouge and powder intended to give the dead the appearance of life.

It’s time to bury it.



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