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.