On Monday, the Congressional Budget Office (CBO) projected that the Republicans' no good very bad Affordable Care Act repeal bill would result in 22 million more uninsured Americans by 2026, $772 billion cut from Medicaid, and a relatively modest deficit reduction of $321 billion over a decade. It's barely a healthcare bill, but rather, according to Vox's analysis, "400 families gaining a tax cut that is offset by ending a program that covers three-quarters of a million of low-income Americans."
Voting for a bill that benefits a small group of elites while making healthcare unaffordable for a large number of your constituents might seem bad, but if the GOP is good at anything, it's repackaging policies that hurt the poor into something more palatable, like freedom from taxes and government.
The good news for the majority of Americans who dislike this bill is that the damning CBO report may jeopardize the passage of the Better Care Reconciliation Act (the name for the Senate version GOP healthcare bill). Senator Susan Collins, a Maine Republican, said she would vote no on the bill because it "doesn't fix ACA problems for rural Maine. Our hospitals are already struggling. 1 in 5 Mainers are on Medicaid." Dean Heller, a Nevada Republican facing reelection next year, has raised similar concerns.
But other Republicans, who run every branch of our government, have spent the last 24 hours trying to spin their bullshit into gold.
White House adviser Kellyanne Conway suggested Medicaid recipients (many of whom are children or disabled people) ought to consider getting better jobs in order to get employer-provided insurance. Republican Senator Pat Toomey cried "fake news," releasing a statement that asserted, "The Congressional Budget Office's coverage estimates are based on dubious assumptions."
Others have been less dismissive of the CBO report, instead focusing on the parts that make the bill seem good for middle- and low-income Americans. Let's take a tour, shall we?
The claim: the bill lowers premiums.
Senate Majority Leader Mitch McConnell, the midwife coaxing this bill into the world, pointed out that under the Republican plan, premiums would be 30 percent lower in 2020 compared to the ACA. But what he neglects to mention is that the reason premiums would be lower is because people would by and large receive worse coverage. In many cases, their deductibles would dramatically increase. The CBO report estimates that for folks earning $11,500, "the deductible would be more than half their annual income." With that meager level of coverage, the CBO predicts that a lot of people wouldn't even bother to buy insurance, even if they qualified for a subsidy.
The claim: 22 million Americans will choose to go without insurance.
The way House Speaker Paul Ryan sees it, 22 million aren't losing insurance. Rather, as he said on Fox & Friends, "If you're not going to force people to buy something that they don't want, then they won't buy it. So it's not that people are getting pushed off a plan, it's that people will choose not to buy something they don't like or want."
Ryan's justification isn't wrong entirely—the GOP healthcare bill does away with the individual mandate, though it still intends to punish anyone who lets their coverage lapse for over 63 days by prohibiting them from getting insurance for six months. So a lot of people who were just buying insurance to avoid the penalty will drop out of the market.
But Ryan ignores an important reason people might let their insurance lapse—because the GOP healthcare plan will make it unaffordable for them.
There's also a chance that after the mandate ends, so many healthy people will choose not to buy insurance that the markets, made up increasingly of sick people who are more expensive to cover, will go into a "death spiral." The more people who have coverage, the more stable an insurance system is likely to be. It's almost as if a single government-run plan would solve a lot of problems!
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The claim: Medicaid spending will actually increase.
Texas Republican John Cornyn said that "Medicaid spending would go up year after year under BCRA," which is technically true, though it is far more complicated than that because the Republican healthcare bill would change the way Medicaid is funded. As Vox so eloquently explains (emphasis mine):
Currently, the federal government matches state spending on Medicaid, offering about $1 to $2.79 for every dollar states spend on it. Poorer states get a bigger match. But the BCRA would change all that.The AHCA would cap the state match at a set amount of money per person. Until 2025, the amount would grow from year to year according to the medical component of the Consumer Price Index, to account for inflation. Then it would switch to the overall CPI... So switching to a per capita cap and tying increases to CPI is essentially a federal cut to Medicaid amounting to hundreds of billions over 10 years. In total, the CBO finds that the bill cuts Medicaid by $774 billion over ten years — and by much more over a longer time horizon.
The Republican bill will make insurance less affordable for millions, scale back Medicaid, and yes, likely result in some people dying sooner than they would have. In exchange, some rich people and medical device manufacturers get a tax cut. That sounds bad. No wonder so few Republicans are eager to defend it honestly.
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