Those of us who have been around conservative politics for a while will remember the smirk on Democratic Senate Majority Leader George Mitchell’s face when he got President George HW Bush to destroy his presidency by abandoning his “no new taxes” pledge.
That same smirk is flitting across establishment Republican Speaker of the House Paul Ryan’s face as he rams his Obamacare 2.0, RINOcare or Ryancare health care bill through the House while claiming support from President Trump.
There are two main reasons for why Ryancare is such a disaster for President Trump; the first is that Ryancare is merely Obamacare with a big government establishment Republican spin on it, and the second is that it continues to be most financially burdensome to the small businesses and independent workers who were a key component of Trump’s electoral coalition.
It’s a twofer for Ryan: He and his big government DC pals continue to control people’s lives by controlling the health care and health insurance market and they screw Trump in the process.
For those innocent souls who are inclined to take serial liar Paul Ryan at his word about his bill, the Texas Public Policy Foundation has published an outstanding chart detailing how Ryancare retains the most burdensome regulations and aspects of Obamacare.
You can access a simple side-by-side chart through this link.
As our friend Daniel Horowitz documented, most of the regulatory structure and the Obamacare exchanges are left in place.
There is no innovation, and no way to lower costs. While some of the regulations are tweaked with more flexibility, the 800-pound gorilla in the room — guaranteed issue mixed with community rating (which is responsible for almost all of the premium hikes) — is left in place. Nor does this bill repeal the mandated essential benefits, which require insurers to cover a specific number of people and sex change operations, maternity care for men, etc.
While the “American Health Care Act” blows up the insurance market in order to mandate coverage of the sick, it still throws a whopping $100 billion at states in order to further subsidies to the poor and the sick (on top of Medicaid expansion and exchange subsidies).
Furthermore, says Horowitz, the existence of the exchanges and the subsidies being steered to those exchanges will force insurers to continue competing for government-run health care that is actuarially insolvent. This continued structure will ensure that startup companies — which lack economies of scale to operate within this rigid (albeit slightly relaxed) structure — cannot enter the market. That is the core of what ails the health care industry.
By leaving the price-hiking regulatory and subsidy structure in place, yet repealing the individual mandate, this bill will exacerbate the death spiral because people like myself — who are getting crushed with ridiculous premiums — will dump their insurance. Likewise, employers who are now forced to provide insurance will quickly dump their employees from their plans.
This is what happens when Republicans focus on coverage numbers at the expense of lowering costs through the regulatory structure. They achieve neither. While the individual mandate is replaced with a provision mandating that insurance companies charge individuals who dropped their insurance an extra 30 percent when reenrolling, that provision doesn’t take effect until 2019. The adverse selection and death spiral will be terminal by then, and the employer mandate is not replaced at all.
Also, the 40 percent Cadillac tax on more expensive health plans is delayed from 2020 until 2025, but not repealed.
And, as our friend Katie McHugh writing for Breitbart documented, Ryan’s bill actually strips out even Obamacare’s weak protections preventing illegal aliens from signing up for health care meant for citizens.
And who gets screwed by all of this?
About 22 million individuals currently receive subsidized health coverage through the exchanges (8 million) and the Medicaid expansion (14 million). For them, Obamacare’s higher insurance costs are offset by the law’s subsidies.
However, that is not the case for another group of about 25 million Americans with unsubsidized individual-market coverage (10 million people) or small-employer plans (at least another 15 million people).
Those 25 million are the ones who most need relief from Obamacare, and have the strongest motivation to politically support repeal and replace. Edmund Haislmaier of the Heritage Foundation points out that their real-life experience of Obamacare has basically been “all pain, no gain,” as they have been subjected to significant premium increases and coverage dislocations with no offsetting subsidies.
Unfortunately, Ryancare provides no meaningful relief for that group that is most adversely affected by Obamacare and most supportive of repeal – and most likely to have voted for President Trump.
Thus, House Republicans have replaced the notorious taxes, regulations, subsidies, and mandates of Obamacare with… taxes, regulations, subsidies, and mandates. Except, this time, Republicans, and President Trump, will own it.