Trumpcare? Ryancare? Obamacare Lite? Unaffordablecare? Unpassablecare? There are good reasons for any of these nicknames for the new Republican health-insurance plan. President Donald Trump won the election that makes possible a major change in U.S. health-care policy. House Speaker Paul Ryan envisioned the change and made the policy choices for the bill now making its way through Congress. Former President Barack Obama and his Democratic Congress created the law that Republicans loved to hate, until they tried to undo it and found it would cost a lot and antagonized many members of their party.
The Republican bill is formally known as the American Health Care Act. If enacted, it probably will be the Democrats’ favorite target for years, just as Obamacare was the Republicans’ favorite target. But it’s also a target for Republicans who say it doesn’t go far enough.
One of the Republican radicals, Rep. Dave Brat of Virginia, said flat out last week that “we have to get our national health system focused on cost reduction and not coverage.”
That’s not the message that Ryan wants people to hear from his party. The program he’s selling is one that reduces government spending, cuts taxes, increases patient choice, and ends the federal mandate to buy health insurance. He offers all that and universal access to health care. (Credibility is not included in the price of the ticket.)
Democrats are virtually certain that the Republican measure will force greater federal spending, even while it insures fewer people. They are hoping that the Congressional Budget Office will agree, and publish a fiscal note that embarrasses wavering Republicans into delaying or even killing the bill. This hope, too, is not credible: The Republicans have to act, or suffer electoral consequences.
Ryan knows this. In speeches and news conferences, he has been warning that Republicans have no real choice, because Obamacare is about to fail. Premiums are rising rapidly in the individual health-insurance market, up an average 25% this year. About a third of U.S. counties have only one insurer offering plans. And it will get worse.
Rising premiums and falling participation mean a death spiral for any insurance plan, in which too little money chases too many claims. And then Republicans, as the party in power, will get the blame.
Ryan summed up the dilemma this way: “Are we going to just let this law collapse and whatever happens, happens? Or are we going to do what we said we would do? Are we going to repeal and replace Obamacare with something better?”