No wonder they kept the plan in a locked room!

Paul Ryan introduces his healthcare plan
Paul Ryan introduces the American Health Care Act

| After eight years of voting to "repeal and replace" Obamacare, the Republicans finally hold control of the House, the Senate, and the White House, so it was time to put up or shut up. It would have been better to shut up, because the newly unveiled American Health Care Act is not about Health, nor Care, nor is it very American. It is an act — a mean betrayal of those millions who voted for Donald Trump and his promises to "take care of everybody" with a beautiful plan.

Ryan's intent was to ram the act through the House before anybody had a chance to really read or think about it. Well, that didn't work out so well. Suspicions were aroused when two of the committees with jurisdiction held all-night "mark-up" sessions to vote the act out of committee without the benefit of any expert testimony or hearings. Nor did they wait for the Congressional Budget Office to render its analysis of the bill's impact and effect on the budget. Never mind.

But Ryan was soon under fire from all directions anyway. Various healthcare organizations lamented the harmful effects the bill would have. Even staid AARP came out against it because the bill would be unfair and hurtful to old people. Moderate Republicans (and these days "moderate" just means "not crazy") lamented the effect it would have on people in their states, especially those who rely on Medicare. Senator Tom Cotton (R-Ark) went so far as to say out loud that the bill as written could not pass the Senate. And the theological right-wing christened the bill "Obamacare Lite" because it didn't go far enough to hurt people. 

Two bits of analysis in the CBO report tell you almost everything you need to know.

Ballooning number of uninsured. The CBO concluded that there would be an immediate, steep increase in the number of uninsured. By 2026, the number of uninsured will exceed the number of uninsured before Obamacare was even enacted, thereby obliterating the positive effect of O'care.

number of uninsured
If Ryan-no-care is enacted, the number of uninsured people rises dramatically

Help those who don't need it; hurt those who need help the most. The most damning analysis in the report, IMHO, is that around what will happen to premiums for people of different ages and incomes. The charts below show how much people at different ages will pay for insurance at two different income levels.

Insurance premiums as a percentage of income for different ages at two different income levels

The charts above are worth studying a bit to let the meanness and craziness of Ryan-no-care really sink in.

Take a single individual earning $26,500 in income — $510 per week. Under Obamacare, a 21-, 40-, and 64-year old would each pay 6.4% of their income for their health insurance. Under the Ryan plan, the 21-year old pays a bit less, the 40-year old about 50% more, and the 64-year old has to pay over nine times as much, or 60% of his income. Nobody can afford to pay 60% of their income for healthcare!

Now take a single individual earning $68,200 in income — $1310 per week. The 21- and 40-year olds pay a whole lot less under the Ryan plan, and the 64-year old pays a little less. Apologists for the Ryan-no-care would say that those low premiums encourage the younger, healthier individuals to buy insurance, and since they will require less care, it will cost less to insure them. Sure.

But the important thing to look at is that as you earn more money, you pay less for your healthcare! Thus, the plan afflicts the afflicted and benefits those who need help less.

Big tax cuts. The other salient feature of Ryan's plan is that while he strips help away from those who need it, it gives bushels of money to those who already have plenty. The good news in the CBO report for the Republicans is that, despite the big tax breaks, the deficit will also fall. That's because pulling the rug out from under so many millions will save a lot of money. And that's a good thing, if the only thing you care about is creating a Lord of the Flies society in which it is one for himself and none for all.

And by the way, I think it's best to call this "Ryancare" rather than "Trumpcare." Ryan has been jonesing to shred the social safety net for years, and this is undeniably his plan. In any case, when it all goes south, as it surely will, Trump will make sure that Ryan shoulders the blame, so let's just get a start on it.

Signe Wilkinson
Signe Wilkinson
Nick Anderson
Nick Anderson
Mike Luckovich
Mike Luckovich

Last updated on Apr 13, 2018



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