With the Congressional Budget Office expected to release its official score of his party’s proposed legislation to replace the Affordable Care Act, House Speaker Paul Ryan on Sunday tried to get out in front of the agency’s expected prediction of widespread losses of health insurance coverage. In an appearance on CBS’s Face the Nation Sunday morning, he explained that if millions of people go without health coverage because of the GOP plan, it won’t be because of bad policy. It will be because of freedom.
“The one thing I'm certain will happen is CBO will say, ‘Well, gosh. Not as many people will get coverage,’” he told host John Dickerson. “You know why? Because this isn't a government mandate. This is not the government that makes you buy what we say you should buy and therefore the government thinks you're all going to buy it.”
Ryan insisted that despite slashing funding for Medicaid and vastly reducing the assistance low-income people receive for paying insurance premiums, that health insurance under the GOP-proposed American Health Care Act, will become more accessible. That’s because, he said, the ACHA will increase choice and competition, and thereby lower prices, presumably by at least as much as the many thousands of dollars per year that low-income Americans will lose in subsidies.
In the end, he said, if millions of Americans who now have insurance find themselves without it, it won’t be because they can’t afford it. It will be because they choose not to have it. “We're not going to make an American do what they don't want to do. You get it if you want it. That's freedom.”
Ryan’s view is, to say the least, not widely shared by the medical community or advocates for the populations likely to be most affected by the proposed changes to existing law. The ACHA’s proposal to replace subsidies linked to income with refundable tax credits linked to age was particularly bothersome to the American Medical Association, which has warned that the credits are too small to cover the costs of health insurance.
“It is important...that the amount of credits available to individuals be sufficient to enable one to afford quality coverage. We believe that credits should be inversely related to an individual’s income,” the association’s executive vice president, Dr. James Madara, wrote in a letter to Congress. “This structure provides the greatest chance that those of the least means are able to purchase coverage. We believe credits inversely related to income, rather than age as proposed in the committee’s legislation, not only result in greater numbers of people insured but are a more efficient use of taxpayer resources.”
The elder advocacy group AARP warned that the tax credit system would end up costing low-income seniors not yet eligible for Medicare up to $8,400 a year in increased costs and that a proposal to cut and cap Medicaid funding would effectively eliminate the last resort for many poor people seeking health coverage.
“In providing a fixed amount of federal funding per person, this approach to financing would likely result in overwhelming cost shifts to states, state taxpayers, and families unable to shoulder the costs of care without sufficient federal support. This would result in cuts to program eligibility, services, or both – ultimately harming some of our nation’s most vulnerable citizens,” the group senior vice president for public affairs, Joyce A. Rogers, said in a letter to Congress.
On Sunday, Dickerson asked Ryan about all the opposition the plan has been facing, including from Republican senators who have called on the House to slow down rather than trying to push through a bill that, currently, doesn’t have enough support to pass in the Senate.
The Speaker said that waiting isn’t an option, claiming that the current system is in imminent danger of collapse. Also, freedom.
“This is historic, and it's significant,” he said. “And if we don't act, the system's going to collapse. And the beautiful thing about this plan that we're proposing, it's more freedom. It's more choices. It's more markets. It's lower prices, which gets us better access.”
Returning to the pending CBO report on the ACHA, Dickerson asked again about the number of people who could be expected to lose coverage under the bill. Ryan refused to accept the premise of the question.
“I can't answer that question,” he said. “It's up to people. Here's the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country.”
The next move in this game will come Monday or Tuesday, with the CBO’s estimate of how many Americans would be forced to exercise their “freedom” to go without health insurance under ACHA.