This is the world of Ryancare


February 24, 2017

Earlier this month, House Republicans unveiled what they described as a plan for “repealing and replacing” the Affordable Care Act. The plan, however is not really a plan. It comes with no price tag, no explanation of how many million Americans would lose their current coverage, of how much more Americans would have to pay out-of-pocket for health care, of how pre-existing conditions would be covered, and of what would happen to the 74 million Americans who receive benefits under Medicaid if this program were left to the states to pay for and implement.
Indeed, the 19-page “plan” released by the GOP amounts to little more than talking points – or, as the New York Times’ editorial board put it, a “half-baked policy paper.” Still, one has to start somewhere. So we at Voices for Human Needs decided to take a look at the talking points and – with the help of allies such as the Center on Budget and Policy Priorities and Families USA – provide our own analysis.

Let’s begin.

GOP talking point: Obamacare has failed. Six years after the enactment of Obamacare, here’s what we know: The law has failed the American people. Insurance markets are collapsing. Premiums and deductibles are soaring. Patients’ choices are dwindling. The law has failed to deliver on its core promises.

Our take: the Affordable Care Act has provided coverage to an additional 20 million Americans. The rate of uninsured Americans has dropped all the way to 8.6 percent, at least as of last September – it could be even lower today. Percentage wise, that’s the fewest number of uninsured Americans we’ve seen in our country, ever. And millions of Americans have benefited from improvements in required benefits, people with pre-existing conditions no longer have to fear they won’t be covered, and young adults can stay on their parents’ plan until they turn 26. In addition, consumers are receiving more coverage at less cost than before the ACA was implemented. Finally, polls show the Affordable Care Act reaching new heights of popularity.

GOP talking point: The law is only getting worse. While we could simply allow the law to collapse, that would not be fair to the American families struggling under Obamacare. The truth is, left unaddressed, the situation would only get worse – with even fewer coverage options and even higher costs.

Our take: This talking point is disingenuous. While health insurance remains far more accessible and affordable to millions of Americans than before ACA, Congress has refused to make course corrections that would build on its successes.  Instead, without a single, concrete action by Congress, the current administration already is attacking the Affordable Care Act – and, by extension, American families — on several fronts. First, it curtailed advertising aimed at convincing younger, healthier Americans to enroll in the program, causing overall enrollment numbers to drop among a demographic whose participation in the ACA is crucial to its solvency. Second, the administration shortened the enrollment period for no apparent reason other than a desire to make it harder to enroll. Third, the administration, through the Department of Health and Human Services, in February proposed regulatory changes to the Affordable Care Act, one of which would allow insurers to reduce benefits and force people to pay higher deductibles on future policies. That is a direct hit on American families.

GOP talking point: Repeal is relief. That’s why, when the House returns after President’s Day, we will act to repair the damage done by Obamacare by repealing the law and replacing it with a better system. We will deliver on our promise to the American people.

Our take: “Scratch that,” said the New York Times. “Republican leaders in the House and Mr. Trump’s secretary of health and human services released a plan last week that would provide insurance that is far inferior, shift more medical costs onto families and cover far fewer people.”

The GOP “plan” is similar to legislation passed by Congress last year and vetoed by President Obama. According to an analysis provided by the Center on Budget and Policy Priorities, that measure would have resulted, over the course of a decade, in a shocking 32 million people losing coverage and individual market premiums doubling – yet another devastating hit on American people. Far from “delivering on [their] promise,” the GOP approach would take away access to health care while actually making many families pay more – an approach the New York Times described as “Ryancare: You can pay more for less!”

GOP talking point: A stable transition. Our efforts will ensure protections for the most vulnerable, and there will be a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.

Our take: Of all the talking points the GOP has offered, this one might come closest to being an outright prevarication. If we were to define the “most vulnerable” health care consumers as, say, those receiving Medicaid benefits, then we see the GOP’s plans for these low-income recipients represent a sharp shock.

As Families USA puts it, “The plan includes sweeping changes to Medicaid that would end the Medicaid expansion’s extra payment to states, effectively ending the program. It also ends traditional Medicaid, replacing the current funding structure with per capita caps.”

Families USA notes that, similar to the GOP outline released last week, a previous plan put forth last summer by House Speaker Ryan would let states choose whether to accept federal Medicaid funding as a per capita cap or block grant.  “While the plan is short on details, like the level of federal funding, it’s clear that federal funding would be well below levels under current law,” Families USA notes. “The budget approved [last year] by the Republican-controlled House Budget Committee and supported by Ryan is a good window into the level of federal cuts envisioned. That proposal would cut state federal Medicaid funding by $1 trillion over 10 years.”

Later in the GOP’s talking points document, members claim their plan “modernizes and strengthens Medicaid to protect the most vulnerable.”

Again: this is what we call a prevarication, to use the nice word.

There’s more, but you get the picture. There is currently no effective plan to replace the Affordable Care Act. The premises – i.e., talking points — that underline the “need” for ACA replacement are nothing more than stealth attacks on low-income Americans, who would suffer greatly as Medicaid expansion is ended and much of the rest of Medicaid dismantled beyond recognition. And they are attacks on middle-income Americans, who would see premiums and deductibles rise, fewer medical services covered, and the possibility of a return to the dark days of lifetime caps on coverage and no coverage for pre-existing conditions.

This is the world of Ryancare.

Fortunately, it is by no means a world inhabited by all Republicans. Some GOP senators, including Lisa Murkowski (R-AK) and Susan Collins (R-ME) have voiced strong apprehension over repealing the ACA without a suitable replacement – and Murkowski has gone even farther, warning against ending the Medicaid expansion.

Too, Republican governors are weighing in. In the same New York Times editorial quoted above, Governors John Kaisch of Ohio and Rick Snyder of Michigan have praised the Medicaid expansion because it has helped reduce uncompensated care at hospitals and provided addiction treatment to people suffering from the opioid epidemic. “Thank God we expanded Medicaid, because that Medicaid money is helping to rehab people,” Kasich said recently.

Now that’s a talking point.

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