RyanCare: There is no good, just bad and ugly

Readability

RyanCare: There is no good, just bad and ugly

On Mon­day, March 6th a thud so loud it reg­is­tered on the Richter Scale was heard all across the United States. That thud was the sound of Speaker Paul Ryan’s Oba­maCare replace­ment plan being released. Very quickly his replace­ment plan was greeted by a cho­rus of angry crit­i­cism from the Free­dom Cau­cus, Free­dom Works, the Tea Party Patri­ots, and so many other conservative/​libertarian orga­ni­za­tions. All of those orga­ni­za­tions saw Speaker Ryan’s pro­posal as a betrayal of their prin­ci­ples. Labels such as Oba­maCare 2.0, Oba­maCare Lite, Ryan­Care, and RinoCare were imme­di­ately thrown at the proposal .

Here is an excerpt from a Sen­a­tor Rand Paul inter­view, which was pub­lished in this Bre­it­bart Arti­cle, where he crit­i­cizes Speaker Ryan’s legislation.

I think the rea­son why the House lead­er­ship bill is Oba­macare Lite is because it retains sub­si­dies. Oba­macare had sub­si­dies for peo­ple to buy insur­ance. In the Paul Ryan bill, they keep the sub­si­dies — they just call them refund­able tax cred­its. Some peo­ple are pre­dict­ing that it’s actu­ally going to be more expen­sive than the sub­si­dies we have under Oba­macare. This isn’t you get­ting your own money back, this is you get­ting some­body else’s money

The sec­ond thing that Paul Ryan’s Oba­macare Lite bill does is they keep the Oba­macare taxes — all of them — for a year. And then after a year, they keep the Cadil­lac Tax for­ever. That’s the tax on if you have really good insur­ance, Oba­macare taxes that. So will Paul Ryan’s plan.

The third thing they do that is Obamacare-​like is they keep the indi­vid­ual man­date. It seems like every Repub­li­can says they were against the indi­vid­ual man­date. That’s if you didn’t buy insur­ance you had to pay a penalty to the gov­ern­ment, a tax. Oba­macare Lite, Paul Ryan’s plan, just changes it so you have to pay a penalty to the insur­ance companies.

Then the fourth thing they do is they actu­ally sub­si­dize the insur­ance com­pa­nies. Right now, insur­ance com­pa­nies are los­ing money and Oba­macare has this res­cue thing called ‘risk cor­ri­dors’ to bail out the insur­ance com­pa­nies. Paul Ryan has got the same thing, he just calls it rein­sur­ance and it’s $100 mil­lion worth. I pre­dict that might not even be enough.

Speaker Ryan claims that his pro­posal is the best that can be done, because the repeal and replace needs to be done under Bud­get Rec­on­cil­i­a­tion, to avoid a Demo­c­rat fil­i­buster in the Sen­ate. Accord­ing to Speaker Ryan his leg­isla­tive pro­posal is just step one in a 3 step process. Here is how he describes this process on his offi­cial website

As Speaker Ryan explained at his press con­fer­ence, this approach has three over­ar­ch­ing phases:

The Amer­i­can Health Care Act, which takes full advan­tage of the bud­get rec­on­cil­i­a­tion process to avoid a Demo­c­ra­tic filibuster;

Admin­is­tra­tion actions, notably by HHS Sec­re­tary Price, to sta­bi­lize the health insur­ance mar­ket, increase choices, and lower costs; and

Addi­tional leg­isla­tive poli­cies, such as allow­ing indi­vid­u­als to pur­chase cov­er­age across state lines, that by Sen­ate rules can­not be included in a rec­on­cil­i­a­tion bill.

Unfor­tu­nately, Speaker Ryan’s orig­i­nal pro­posal is such a mis­er­able start­ing point for this Her­culean effort it makes achiev­ing any­thing worth­while nearly impossible.

Many Repub­li­cans have stated that Speaker Ryan’s pro­posal is open to amend­ments. This is what Rep­re­sen­ta­tive Mark San­ford had to say about amend­ments in this Bre­it­bart Arti­cle:

With regard to a health­care bill mov­ing for­ward, I see leadership’s health­care plan as an open­ing proposal,

The debate that is form­ing will allow con­ser­v­a­tives to enhance and improve what has been pro­posed, and I think this could rep­re­sent a win for patients, health­care providers, and the tax­payer alike.

Hope­fully major amend­ments to Speaker Ryan’s pro­posal will be allowed, but I’m not at all opti­mistic about that.

Why is Speaker Ryan’s pro­posal such a mis­er­able first attempt? Con­ser­v­a­tive Review has a very insight­ful the­ory which they shared in this Arti­cle

In order to ben­e­fit indi­vid­u­als, a plan would have to focus on choice, com­pe­ti­tion, flex­i­bil­ity – the things that allow peo­ple to pur­chase what best suits their needs. Enter the next act in the health care reform drama – Paul Ryan’s “Amer­i­can Health Care Act” (AHCA for short). Repub­li­cans believe in free mar­kets, right? So clearly the fun­da­men­tal under­pin­nings of a Republican-​designed health care plan will focus on free­dom and indi­vid­ual choice, right? Uh … right?

A close look at the AHCA reveals a dif­fer­ent oper­at­ing phi­los­o­phy, one more tied to pre­serv­ing the sta­tus quo and appeas­ing indus­try inter­ests than to improv­ing cost of care, and choice for indi­vid­u­als. Put more sim­ply, Paul Ryan’s Oba­macare sub­sti­tute is fun­da­men­tally geared toward keep­ing a sta­ble cus­tomer base for insur­ers and encour­ag­ing uni­ver­sal insur­ance cov­er­age rather than toward enabling a free mar­ket for health care.

Accord­ing to this arti­cle, The Fed­er­al­ist has a the­ory about why Speaker Ryan’s pro­posal fails to repeal ObamaCare:

If you want to know why Repub­li­cans have bogged down, notice one pecu­liar thing about the Oba­macare debate so far. It’s not really a debate over Oba­macare, it’s a debate over Med­ic­aid. That’s because Oba­macare mostly turned out to be a big expan­sion of Med­ic­aid. The health insur­ance exchanges that were sup­posed to pro­vide afford­able pri­vate health insur­ance (under a gov­ern­ment aegis) never really delivered.

Ever since the pas­sage of Oba­maCare, Repub­li­can were united under the ban­ner of full repeal and then replace. Unfor­tu­nately, Speaker Ryan’s pro­posal is only a par­tial repeal. After the release of Ryan­Care, the Repub­li­cans are now seri­ously, if not hope­lessly, divided. I believe only a return to full repeal will unite the Repub­li­can Party. After the full repeal then the Repub­li­cans can pass a free mar­ket, patient cen­tered replace­ment such as the one Sen­a­tor Rand Paul authored. Here is a link to his plan: Rand Paul Plan.

On Monday, March 6th a thud so loud it registered on the Richter Scale was heard all across the United States.  That thud was the sound of Speaker Paul Ryan’s ObamaCare replacement plan being released.  Very quickly his replacement plan was greeted by a chorus of angry criticism from the Freedom Caucus, Freedom Works, the Tea Party Patriots, and so many other conservative/libertarian organizations.  All of those organizations saw Speaker Ryan’s proposal as a betrayal of their principles.  Labels such as ObamaCare 2.0, ObamaCare Lite, RyanCare, and RinoCare were immediately thrown at the proposal .

Here is an excerpt from a Senator Rand Paul interview, which was published in this Breitbart Article, where he criticizes Speaker Ryan’s legislation.

I think the reason why the House leadership bill is Obamacare Lite is because it retains subsidies. Obamacare had subsidies for people to buy insurance. In the Paul Ryan bill, they keep the subsidies—they just call them refundable tax credits. Some people are predicting that it’s actually going to be more expensive than the subsidies we have under Obamacare. This isn’t you getting your own money back, this is you getting somebody else’s money

The second thing that Paul Ryan’s Obamacare Lite bill does is they keep the Obamacare taxes—all of them—for a year. And then after a year, they keep the Cadillac Tax forever. That’s the tax on if you have really good insurance, Obamacare taxes that. So will Paul Ryan’s plan.

The third thing they do that is Obamacare-like is they keep the individual mandate. It seems like every Republican says they were against the individual mandate. That’s if you didn’t buy insurance you had to pay a penalty to the government, a tax. Obamacare Lite, Paul Ryan’s plan, just changes it so you have to pay a penalty to the insurance companies.

Then the fourth thing they do is they actually subsidize the insurance companies. Right now, insurance companies are losing money and Obamacare has this rescue thing called ‘risk corridors’ to bail out the insurance companies. Paul Ryan has got the same thing, he just calls it reinsurance and it’s $100 million worth. I predict that might not even be enough.

Speaker Ryan claims that his proposal is the best that can be done, because the repeal and replace needs to be done under Budget Reconciliation, to avoid a Democrat filibuster in the Senate.  According to Speaker Ryan his legislative proposal is just step one in a 3 step process.  Here is how he describes this process on his official website

As Speaker Ryan explained at his press conference, this approach has three overarching phases:

The American Health Care Act, which takes full advantage of the budget reconciliation process to avoid a Democratic filibuster;

Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs; and

Additional legislative policies, such as allowing individuals to purchase coverage across state lines, that by Senate rules cannot be included in a reconciliation bill.

Unfortunately, Speaker Ryan’s original proposal is such a miserable starting point for this Herculean effort it makes achieving anything worthwhile nearly impossible.

Many Republicans have stated that Speaker Ryan’s proposal is open to amendments.  This is what Representative Mark Sanford had to say about amendments in this Breitbart Article:

With regard to a healthcare bill moving forward, I see leadership’s healthcare plan as an opening proposal,

The debate that is forming will allow conservatives to enhance and improve what has been proposed, and I think this could represent a win for patients, healthcare providers, and the taxpayer alike.

Hopefully major amendments to Speaker Ryan’s proposal will be allowed,  but I’m not at all optimistic about that.

Why is Speaker Ryan’s proposal such a miserable first attempt?  Conservative Review has a very insightful theory  which they shared in this Article

In order to benefit individuals, a plan would have to focus on choice, competition, flexibility – the things that allow people to purchase what best suits their needs. Enter the next act in the health care reform drama – Paul Ryan’s “American Health Care Act” (AHCA for short). Republicans believe in free markets, right? So clearly the fundamental underpinnings of a Republican-designed health care plan will focus on freedom and individual choice, right? Uh … right?

A close look at the AHCA reveals a different operating philosophy, one more tied to preserving the status quo and appeasing industry interests than to improving cost of care, and choice for individuals. Put more simply, Paul Ryan’s Obamacare substitute is fundamentally geared toward keeping a stable customer base for insurers and encouraging universal insurance coverage rather than toward enabling a free market for health care.

According to this article, The Federalist has a theory about why Speaker Ryan’s proposal fails to repeal ObamaCare:

If you want to know why Republicans have bogged down, notice one peculiar thing about the Obamacare debate so far. It’s not really a debate over Obamacare, it’s a debate over Medicaid. That’s because Obamacare mostly turned out to be a big expansion of Medicaid. The health insurance exchanges that were supposed to provide affordable private health insurance (under a government aegis) never really delivered.

Ever since the passage of ObamaCare, Republican were united under the banner of full repeal and then replace.  Unfortunately, Speaker Ryan’s proposal is only a partial repeal. After the release of RyanCare, the Republicans are now seriously, if not hopelessly,  divided.  I believe only a return to full repeal will unite the Republican Party.  After the full repeal then the Republicans can pass a free market, patient centered replacement such as the one Senator Rand Paul authored.  Here is a link to his plan: Rand Paul Plan.