In a town hall last night, House Speaker Paul Ryan repeated the talking point. “The status quo is not an option. Obamacare is not working,” he said, “We’ve got dozens of counties around America that have zero insurers left.”
It used to be true that dozens of counties lacked any insurer for the exchanges. This was not a good argument against Obamacare, since the lack of insurers was largely a result of the Trump administration deliberately driving them out. Nor was it a good argument for the Republican replacement, the largest effect of which was to slash funding for Medicaid, a solution not even plausibly related to the separate problems of the exchanges. But it was, at least, an argument for action of some kind.
At this point, that “fact” is no longer a fact. With the threat of repeal gone, insurers have filled in the remaining counties without a provider. At the moment there is one county, with 334 enrollees, lacking a provider. Not dozens. (Moderator Jake Tapper, who repeatedly grilled Ryan over his reluctance to denounce President Trump’s comments on race, did not take note of Ryan’s gross error.)
The Republican leadership remains committed to its plan, and Ryan’s official position is still that the House plan was great, and the only problem was the failure of the Senate to pass it. But the justification for that position has gone from tendentiously misleading to outright false, and he hasn’t bothered to come up with a rationale for it that’s even facially correct.
Because Republican health care policies are terrible and almost everyone hates them, defending them almost inevitably involves enormous amounts of chutzpah. My favorite line — used by John Cornyn — is the argument that the ACA has to be repealed because many poor people in Texas remain uncovered, because the state of Texas has turned down the large amounts of federal money being offered to provide coverage to poor people. Another variant is “Obamacare didn’t provide true universal coverage, a problem we will solve by covering tens of millions fewer.” Paul Ryan tries this, with his trademark dishonesty thrown in:
The fact that the ACA isn’t collapsing just makes igniting the dynamite the AHCA planted under the foundations all the more urgent!