At times House Republicans and administration officials sound absolutely daft when defending the American Health Care Act they narrowly passed last week. Rep. Raul Labrador, R-Idaho, will surely appear in most every Democratic ad in 2018 thanks to his nonsensical assertion at a town hall. “Nobody dies because they don’t have access to health care,” he (actually) said.
That was the most laughable but certainly not the only ridiculous assertion by Republicans who seem willing to employ any argument, no matter how implausible or flat-out wrong to justify their votes. Consider this exchange on ABC’s “This Week.” House Speaker Paul Ryan, R-Wis., insisted Republicans were getting rid of job-killing taxes. It went downhill from there:
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GEORGE STEPHANOPOULOS: But most of benefits go to millionaires.
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RYAN: Medicaid – it’s – we’re repealing all of the Obamacare taxes. But the Medicaid, what we’re doing with Medicaid, we’re giving the states the ability to customize Medicaid to meet the particular needs of their vulnerable populations. You’ve got to remember, Medicaid is a program that is administered by the states, but micromanaged by the federal government, and not very well.
More and more doctors are refusing to even accept people with Medicaid. And so we want to give the states the ability to customize the Medicaid program to work for their particular states.
STEPHANOPOULOS: But you’re saying they can do that with $880 billion less. You’re saying they can do it with $880 billion less.
RYAN: We’re – we’re giving states the ability to run their own Medicaid program. And it is increasing for medical inflation.
And by the way, we recognize that for certain people in Medicaid, the disabled, the aged, the people in nursing homes, we’re giving them a bigger increase so that their funds are even more than everybody else. And so by giving states the right to run Medicaid, and giving them a block grant, per capita bloc grant, or a bloc grant, and then increasing that the spending by medical inflation, I hardly think that’s draconian.
STEPHANOPOULOS: So, you don’t think anyone will be hurt when you’re taking $880 billion out of the system?
RYAN: No, no, I don’t, because I think the micro-management of Medicaid by the federal government. The Medicaid system isn’t working. Doctors aren’t taking Medicaid, hospitals can’t survive with Medicaid alone.
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Does anyone really believe that depleting Medicaid by $880 billion will improve reimbursement rates or coverage – especially when the GOP plan explicitly rolls back Medicaid expansion?
Both Ryan and Health and Human Services Secretary Tom Price insisted on the Sunday shows that no one with a pre-existing condition would lack coverage. That’s false given that states were given the right to opt out of protection for pre-existing coverage and the high-risk pools are underfunded by hundreds of billions of dollars. Price continues to dissemble on key aspects of his plan. The Post’s Glenn Kessler explains:
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Price flatly stated that Medicaid spending will go up year after year in the budget, but that’s false. It actually declines in raw dollars after the switch in funding is implemented. Although HHS suggests he was saying that spending would go up by the rate set in the law, that’s still misleading. That’s a fixed amount untethered to the actual expenses of patients, so if the money falls short, states will either have to make up the difference or cut expenses by limiting enrollment or reimbursements.
Price is similarly misleading when he declares that 20 million people have rejected the Affordable Care Act by paying a penalty. . . . In fact, the number of people paying a penalty actually declined by nearly 20 percent from 2014 to 2015, indicating greater acceptance of Obamacare.
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Perhaps Ryan and Price should listen to a GOP governor who will have to deal with the consequences of their legislative malpractice. Ohio Gov. John Kasich blasted Republicans for dissembling. (“This bill . . . is woefully inadequate and very disappointing,” he said during a stop on his book tour in California over the weekend. “Put yourself in somebody else’s shoes – how you would like to not be able to get health insurance because you have a pre-existing condition, or you’re sick or you don’t have money?”)
Contrast Ryan and Price’s rank dishonesty and spin with the calm, factual analysis Sen. Susan Collins, R-Maine, provided Americans: “It’s difficult to assess the new House bill because we still don’t have a CBO analysis of the impact of coverage and costs.” The conversation continued:
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COLLINS: Well, first of all, one of the problems with the House bill is that the tax credits are not adjusted for income or geographic region. That really hurts a state like Maine, where we have an older population living in largely more expensive, rural areas, as far as health care is concerned.
I’ve heard a lot of talk about the Maine high-risk pool. And indeed, it was a success in Maine for the 18 months or so in which it operated before the passage of the ACA and it can be part of the solution. But in Maine, we had definite revenue streams supporting the high-risk pool, and that is why it worked. In the House bill, it’s really up to the states to come up with whatever option they wish.
So that could work and it could be part of a solution. But the devil really is in the details.
STEPHANOPOULOS: So do you agree with the Speaker Ryan and President Trump who are saying people with pre-existing conditions are going have the same coverage they have now, even better, Speaker Ryan said, in some cases, letters of protection, than under Obamacare?
COLLINS: I think that’s unlikely. But so much discretion is given to the states without any guardrails. The difference between that approach and the approach in the bill that Sen. Cassidy and I have introduced is we keep the ACA safeguards, the consumer protections, for people with pre-existing conditions.
It’s true that under the House bill that a state that gets a waiver would still have to provide coverage to people with pre-existing conditions. But that coverage might well be unaffordable. And if the coverage is unaffordable, that doesn’t do any good for a child who has juvenile diabetes and is going have that her entire life. And once she’s no longer on her parents’ policy, that’s going to create problems in some states.
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House Republicans have been so fixated on passing anything that they now find it hard to defend their handiwork without resort to exaggeration, deflection and flat-out dishonesty. There is a surefire way to tell they are not accurately representing the bill: Fellow GOP senators want no part of it.
Jennifer Rubin writes for The Washington Post.