GOP fail on ObamaCare replacement


EddieMunsterThe GOP’s alleged boy genius, Ayn Rand fanboy and Speaker of the House Paul Ryan is The Most Overrated Intellect In Washington. As Paul Krugman said years ago, Ryan is The Flimflam Man.

Having nearly seven years in which to come up with an alternative to the Affordable Care Act aka “ObamaCare,” this is what boy genius comes up with? The Beltway media should revoke his “very serious person” card and stop speaking to him.

Update: It was seven years ago this month that House Republican leaders began promising to unveil a GOP health-care-reform plan, and for seven years, the party has done nothing except offer vague soundbites and vote several dozen times to repeal the Affordable Care Act, replacing it with nothing. (h/t Steve Benen).

Nancy LeTourneau at the Political Animal Blog writes, Speaker Paul Ryan Goes “Post-Truth” on a Health Care Plan:

To the extent that Republicans have become “post policy,” Speaker Paul Ryan seems to be leading the charge to return them to being “post truth.” In other words, he is attempting to revive the old system of pretending to present policy proposals that help Americans, but really just benefit the 1%ers. Nowhere is that more obvious than with his unveiling today of a GOP plan to replace Obamacare.

There is nothing new in this plan. It contains all of the old standbys Republicans have been talking about for a while now: refundable tax credits, health savings accounts, high risk pools, block-granting Medicaid, a voucher program to replace Medicare, etc. Oh, and as Kevin Drum notes, while we’re at it, lets raise the eligibility age for Medicare to 67. But there are two pretty big things that were not included in this “plan”:

1. No budget information on costs

2. No projections on what it would mean for the 20 million people who have gained insurance under Obamacare.

When those kinds of questions come up, here is the response:

Asked about the plan’s effect on coverage, a Republican leadership aide said Monday, “You’re getting to the dynamic effect of the plan and we can’t answer that until the committees start to legislate.”

I’m not sure why Ryan bothered with this. He seems to think that having 37 pages in a report (3 of which are apparently devoted to talking about how bad Obamacare is) will convince us that his reputation as a “wonk” is deserved.

Steve Benen does a great job of identifying why Republicans will always come up short on producing a plan to improve health care coverage.

Republicans haven’t been able to come up with a credible reform package for some pretty obvious reasons: (1) they’re a post-policy party with no real interest in governing; (2) health care reform has never really been a priority for the party, which would prefer to leave this in the hands of the private sector and free-market forces; and (3) trying to improve the system requires a lot of government spending and regulations, which contemporary GOP policymakers find ideologically abhorrent.

UPDATE: Paul Waldman of the Washington Post ads, “The best you can say about it is that it would be a political catastrophe, so it would never pass.” Paul Ryan unveils plan to set fire to the American health-care system. Stephen Stromberg, The Post’s policy commentator writes, Paul Ryan’s shameless Obamacare deception.

As it turns out, ObamaCare is working to to keep costs in check. U.S. will spend $2.6 trillion less on health care than expected before Obamacare, study projects:

A new study predicts that the federal forecast of national health care spending under President Obama’s signature health law was a big overestimate — by $2.6 trillion over a five-year period.

Expanding health insurance coverage to millions of Americans was bound to increase overall spending. After the Affordable Care Act was passed in 2010, the actuaries for the Centers for Medicare and Medicaid Services projected that, as the economy recovered, the historically low growth in health spending would return to higher levels, reaching $4.6 trillion by 2019. But in the intervening years, the annual expenditure increases have been more modest than expected, and the new estimate from the Urban Institute suggests national health spending is on to track reach $4 trillion by 2019.

“When CMS originally made those projections, they really thought the slowdown in health-care spending [growth] was mostly due to the recession, and afterward we’d see a return to the higher rates of spending growth — and that didn’t really happen,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, which funded the new study by the Urban Institute.

Looking forward, the study’s authors also point to recent evidence that a 2014 uptick in health spending that had seemed to signal a return to higher growth may have been temporary. If slower growth persists, they argue that it will become harder to argue that it is just the economy and not the cost containment policies enabled by the Affordable Care Act that are tempering spending.

Hempstead said it’s becoming increasingly plausible that the federal policies included in the Affordable Care Act — and its ripple effects as programs implemented within Medicare influence the private market — are having a tempering effect.


A Kaiser Family Foundation analysis from 2013 found that about three-quarters of the slowdown could be traced to the sluggish economy, and attributed the rest of it to various other factors.

“The hangover from the Great Recession has had significant effects on consumer spending in general, and health spending specifically,” Larry Levitt, a vice president at Kaiser, said in an email. But, he added, the Affordable Care Act “has clearly had a large and direct effect on slowing down health spending in Medicare. Its effect on the rest of the health system is somewhat more speculative, but I believe it’s real.”

Hempstead thinks that some of the policies that came with health reform have contributed. For example, she pointed to a policy that was intended to cut hospital readmissions by introducing financial penalties for hospitals with excessive readmissions. Being readmitted to the hospital isn’t good for patients or for payers — a report by the Agency for Healthcare Research and Quality found that 3.3 million adult hospital readmissions racked up $41.3 billion in hospital costs in 2011. Hospital readmission rates fell after the Affordable Care Act was implemented, both for conditions targeted by policy and those that weren’t.

But another factor that Levitt and Hempstead pointed to was the increase in deductibles. Research has shown that patients with high-deductible health plans simply avoid the use of health care altogether while they are on the hook for their health care costs.

If that’s what’s happening, it could look good for reining in spending in the short term, but may not save money in the long run — or be good for people’s health.