Jay Bookman

Opinion columnist and blogger with The Atlanta Journal-Constitution, specializing in foreign relations, environmental and technology-related issues

Opinion: This is where the mask slips, for all to see

In an interview Monday night on Fox News, House Speaker Paul Ryan repeated his claim that having read the entire CBO report on his party's proposed Obamacare replacement plan, "I'm pretty encouraged by it and it actually exceeded my expectations."

If you're encouraged by that report, anchor Bret Baier asked in disbelief, what kind of CBO report would it take to discourage you?

Ryan responded in deeply revealing terms.

"What CBO did is validate (our approach)," he said, a big grin splitting his face. "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."

It's just remarkable.

Note that Ryan links the $880 billion in proposed Medicaid cuts directly to the $880 billion in proposed tax cuts, as he should. He's excited about that fact. He likes it. He's not the least bit bothered by the CBO projection that those cuts will strip health insurance from 17 million of his fellow Americans who have no other source of coverage -- senior citizens in nursing homes, children living in poverty. This is his Ayn Rand fantasy made true.

Nor does he mention that almost all of that $880 billion tax cut would benefit already wealthy Americans. According to the nonpartisan Tax Policy Center, middle-income Americans would see a tax cut under the GOP bill that averages $300. The top 1 percent -- those already 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.

Put another way, this is where the mask slips, revealing the ugliness that has always been there.

It's also fascinating to see how differently those in the Trump administration are approaching the CBO numbers. While Ryan claims to be enthused and excited by them, for example, 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.)

The problem with Price's claim is that 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. Even if you set aside such reports, simple, basic math tells you that you cannot make changes on the scale being proposed without also producing significant, painful reductions in coverage.

In addition to Medicaid cuts, take a look at the chart at the top of this post. It's produced by the Kaiser Family Foundation, an independent non-profit specializing in health-care policy. The chart offers a straightforward comparison of the subsidies that would be available to a 60-year-old couple under both the Affordable Care Act and the proposed Trumpcare plan.

A couple just scraping by on an income of $25,000 would see their out-of-pocket cost for health insurance jump by as much as $19,000 in a high-cost market such as Mobile, Ala. Even in a low-cost area such as Reno, they would have to pay an additional $10,920 for coverage. They would clearly drop their coverage, and it won't be because they are no longer legally mandated to carry it. They would drop it because financially, they would have no other choice. So add them and many like them to the 17 million cut loose by Medicaid.

As the chart illustrates, even a middle-income couple -- the median household income in this country is a little over $50,000 -- would see significant out-of-pocket increases in the cost of health insurance, so significant that most would simply be unable to afford it. They too would be forced to drop coverage; they too can be added to the 17 million.

All in all, the Republican "replacement plan" would do absolutely nothing to help either low- or middle income people of that age buy insurance, and they're the people who need it most. And it's hard to escape the conclusion that this is probably failure by intent.

Two years ago, the CBO was asked to predict the impact of a straight repeal of Obamacare, with no plan implemented to replace it. In that 2015 assessment, it projected that 24 million Americans would lose coverage, which just happens to be the same number left uncovered by this Republican plan.

Put another way, this "replacement plan" has exactly the same total coverage effect as no replacement plan whatsoever. It is a work of mortuary cosmetology, designed to give the dead the appearance of life and health.

Well, it's time to bury it.



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About the Author

Jay Bookman writes about government and politics, with an occasional foray into other aspects of life as time, space and opportunity allow.