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“I Was Told There Would Be No Math”

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I have a piece in the LA Times about how the Republican Party is so strongly committed to upward wealth distribution and cruelty-for-its-own-sake that it can’t produce a health care bill that can produce a CBO score that can even look good against a phony baseline of their own proposals:

The result would be the worst of both worlds for insurers and the now-insured. Obamacare’s historic expansion of Medicaid would be eliminated, and so would the subsidies that make purchasing insurance on individual exchanges more affordable. But insurers still would be required to issue insurance regardless of preexisting conditions, and this insurance still would have to provide comprehensive coverage.

Guess what would come next? An almost-immediate death spiral: Effective premiums would skyrocket, which means that only the sick and desperate would maintain insurance while healthy people fled the market in droves, causing prices to increase even more. (You may have heard that the ACA is already in a death spiral, but this is simply false — the existing exchanges have, for the most part, stabilized.)

In other words, the ORRA would devastate Medicaid and completely destroy the individual market for health insurance. Maybe the number of people who would lose coverage would be somewhat less than the CBO’s projected 32 million, and maybe it would be even more, but it’s somewhere in that ballpark, and no logical analysis would conclude otherwise.

Although repeal-without-replace is the GOP’s worst idea yet, the party’s latest affirmative replacement plan isn’t all that much better, as the CBO score issued Thursday makes clear. It would cut coverage by 22 million, raise premiums by 20% on average and cut Medicaid by $772 billion while giving the wealthy and corporations $541 billion in tax breaks. Deductibles would be an outright disaster; someone making $26,500 in 2026 would pay $13,000 — or half his income — compared with $800 under the ACA.

So it’s the same old, same old. The House bill that passed in May, as well as the Senate’s two proposals for remaking Obamacare, would all substantially cut the spending that helps people afford insurance on the individual markets. All of these schemes would lead to a huge increase in the number of uninsured. None contain any material benefit to anyone except wealthy taxpayers.

These bills were never going to be popular if scored accurately. There’s just no way to slash costs without slashing the insurance rolls. That’s simple math.

As we recently discussed, if this bill dies in part because the CBO is able to compel the media to print accurate information about Republican healthcare proposals, the GOP may well respond by breaking the CBO.

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