Today was the first reality-check for the Republican goal of health insurance reform since the Patient Protection and Affordable Care Act was passed. The breathtaking numbers from the Congressional Budget Office just proved what many of us have been saying all along -- this is the first time in the past seven years that Republicans have tried to bring an actual piece of legislation to the floors of Congress for a very good reason. The numbers just don't quite add up the way the GOP has long wished they would. By never writing an actual bill before now, they avoided letting the public in on this crucial bit of information. But now it was "put up or shut up" time, so Republicans were forced to come up with an actual bill. And the C.B.O. just confirmed what Democrats have been saying for a long time -- replacing Obamacare is going to throw millions of Americans off health insurance.
Donald Trump's insistence that "everyone will be covered" has now been proven to be a gigantic lie. Everyone will be covered, except for the 24 million who will lose coverage in the next ten years (starting with 14 million who will lose it next year alone). The number of uninsured Americans will skyrocket from the current 27 million to over 50 million. This won't be because (according to Paul Ryan) they never really wanted health insurance in the first place and would now use their expanded "freedom" to refuse to pay for it -- it will instead be because tens of millions of people will not be able to afford insurance. This was always going to be the reality under a Republican revamp of Obamacare, but now that the C.B.O. has finally been given a chance to run numbers on an actual bill, we can all see just how drastic this is going to be for millions of American families.
Last week, while Paul Ryan was attempting to hustle the bill as far as he could as fast as he could (even holding votes on it at 4:30 A.M.), independent analysts were already predicting that millions would lose their insurance. These estimates ranged from a low of about six or seven million up to 15 million. What we now know is that they were actually far too generous in their assumptions. The 24 million figure is so staggeringly larger than anyone expected that it will instantly change the political debate. Even before the C.B.O. numbers came out, there were few Republicans (outside of the White House and Paul Ryan's office) who were vocally supporting the bill in public. How many of them are now going to make the case that 24 million more uninsured Americans is a good thing?
As is true for many issues, Donald Trump wasn't outside the Republican mainstream in his comments on how wonderful GOP health insurance reform would look like. He may have been more direct, but the things he was saying were pretty close to what Republicans had been saying for a long time -- that their Obamacare replacement would cover more people, bring everyone's costs down, and give better results at the end of the day. Trump just put the icing on that cake, he didn't bake it himself, in other words.
Trump, of course, had no actual plan himself, even while loudly insisting that he did. He felt free to expound on how big and beautiful his non-existent plan was going to be, because he intrinsically trusts his own brain to solve any problem no matter how intractable. Turns out he was not only fooling the voters, he was also fooling himself. He even admitted so about a week ago, complaining that health reform was a lot harder than anyone could have ever guessed. "Anyone" except, you know, for pretty much every person inside Congress, just to name 535.
On the campaign trail, Trump was free to boast about the paradise he was going to create in the health insurance industry, and his voters lapped it up. But, tellingly, after he was sworn in as president, no Trumpcare plan appeared. He put off inquiries by moving the goalposts a bit, saying his beautiful reform plan would be announced the day his nominee to head the Health and Human Services department was confirmed by the Senate. This has now happened, but there is still no Trumpcare plan. When Paul Ryan finally unveiled his own plan, Trump quickly embraced it -- but that is not the same thing as coming up with a plan on his own. Few, so far, have even noticed this contradiction.
By tying his wagon to Ryan's plan, Trump (like the rest of the GOP) has been forced into defending reality, rather than just painting visual castles in the air. And the reality is (quite obviously) going to fall far short of Trump's promises. Democrats are already gleefully recycling all of Trump's grandiose promises into talking points of their own, and this could indeed continue all the way to the 2018 midterm elections. As well it should. It's too good a political opportunity to miss, really. All Democrats have to do is run a clip of Trump saying "everyone will be covered" next to the C.B.O. numbers. Or point out the many times Trump pledged not to touch Medicare and Medicaid, together with the reality of Ryan's plan to dismantle as much of Medicaid as he thinks he can get away with. Also buried in the C.B.O. numbers is the fact that the price of insurance is going to immediately head upward -- 15 to 20 percent more than under Obamacare. There's another easy ad for Democrats to make.
Twenty-four million people is a lot, to state the obvious. It is such a large fraction of the American populace that few people will not personally know someone directly (and negatively) affected by Ryan's bill. This is what happens when you simultaneously allow insurers to charge a lot more money while drastically shrinking the subsidies available. It's pretty basic math, and it will even affect Trump voters disproportionately to the public at large.
Ryan and any other Republicans who rally around his plan are going to have a tough sell in the weeks to come. They can try to discredit the C.B.O. report all they want, but while that might have worked if the number was a lot lower (say, six million), it's going to be pretty hard to convince anyone that 24 million uninsured Americans is just "some sort of rounding error."
Ironically, the only good news for Ryan out of the C.B.O. report is that he might now have an easier time convincing the Tea Partiers in his own ranks to vote for the bill. Their main argument has been that the bill is far too generous -- it didn't kick enough people off health insurance, in other words. With the staggering 24 million figure now out, perhaps some of them can now be convinced that the bill actually is Draconian enough for them to support.
But it's certainly not going to help Ryan with the moderate Republicans (especially those in the Senate). Paul Ryan's initial scheme was to get the bill through both houses of Congress and on the president's desk so fast that public opinion wouldn't have time to react. The original schedule Ryan wanted was to pass the bill before the next big congressional vacation period, when they all go home to get an earful from their constituents. This aggressive schedule was never very realistic, but now it looks downright fantastical. Which means we'll have time for some town hall outrage, in the meantime. Because my guess is that a fair portion of the 24 million people who will be affected are going to speak up to their congressional representatives, quite loudly and unequivocally. Which was precisely what Ryan was trying to avoid. The problem all along has been that castles in the air are a lot easier to defend out on the campaign trail, but when actual bills are drawn up they get scored by the C.B.O. Now we can all see precisely what Ryan (and all the rest of the Republicans) have been trying to hide for the past seven years -- they are truly on a mission to throw tens of millions of people off their health insurance. Obamacare so offends their ideological concept of the world that they simply don't care if 24 million Americans again face bankruptcy whenever they get sick. No wonder they haven't written an actual bill before now, because now everyone can see exactly what they stand for -- and it's not a pretty picture.
-- Chris Weigant
Cross-posted at The Huffington Post
Follow Chris on Twitter: @ChrisWeigant