If the House Republicans pass the American Health Care Act this week, as House Speaker Paul Ryan predicts they will, it’ll represent a major triumph of dishonesty over plain, if slightly more complex, truths.

At an obvious level, it will require Republicans to ignore, dispute or lie about the Congressional Budget Office’s conclusion that Trumpcare is likely to cause 14 million people to lose their insurance next year alone and reduce insurance rolls on the whole by 24 million over 10 years, relative to where they’d be if Republicans just administered the Affordable Care Act in good faith.

But at a more cynical level, it will be a victory for the false claims Republicans have made to paper over the fact that their Obamacare alternative would create a humanitarian crisis by cutting off health care assistance to the poor and elderly so that they can massively and permanently cut rich people’s taxes.

If these lies propel the AHCA to passage, though, it is only because they were never seriously, or in sustained fashion, treated as such by leading news outlets covering the Obamacare repeal process. Where the CBO’s coverage findings spoke for themselves, the agency’s other conclusions, and other legislative esoterica, have allowed Ryan and his members to tell a different—and completely false—story about what Trumpcare will mean for people.

That story rests on the following four lies.

1. Trumpcare will reduce premiums

This is the most insidious of falsehoods, because explaining why it’s false isn’t easy. After all, even CBO says, “The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter.” But the CBO’s method of tabulating average premiums only accounts for those who actually buy insurance (not for the average price of premiums on offer) and thus obscures the fact that the “lower premiums” Ryan boasts of stem from the fact that his plan makes insurance unaffordable for the elderly and drives them out of the market altogether.

To see how deceptive this is, consider the following analogy to cars. Imagine America elected an erratic, impulsive person to the presidency, and he was so racist toward Muslims and Latinos that Arab and Latin-American oil exporters decided to impose an embargo against the United States, creating an oil shock. As gasoline prices climbed, the cost of owning and using a car would climb too, inducing some people to trade in their cars for smaller, more fuel efficient ones, or to buy smaller cars than they intended when they entered the market. SUV aficionados might wait until the oil crisis passed altogether to buy their gas-guzzlers. Consumer data would subsequently show the average price of automobiles sold in America falling. But surely nobody in the press corps would take the president seriously if he boasted about such an embarrassing fiasco by claiming he had “lowered car prices.” We would call that person a liar.

This is almost exactly what Paul Ryan is doing, though. Just as “lowering car prices” conveys reducing the average car price within the entire fleet, lowering premiums suggests reducing the amount of money insurers charge on average per available plan. As much as Ryan and nearly every other Republican is pretending otherwise, that’s not what CBO if saying will happen. CBO says average premiums will fall in large part because, “the mix of people enrolled in coverage obtained in the nongroup market is anticipated to be younger, on average, than the mix under current law.” They’re looking at the average price of plans sold.

What Trumpcare does is increase premiums for elderly people so much that many of them will not buy plans at all, lowering the average price of policies purchased on the market. A price shock, but for premiums, instead of oil. This is an extremely cynical and dishonest way of bragging about subjecting millions of seniors to the risks of going uninsured, and Ryan does it constantly.

2. Trumpcare will stabilize the Obamacare death spiral

Ryan says this constantly, too, and is at best asked to defend it against contrary analysis—as if the fact of the matter is open for interpretation. But it isn’t: Obamacare isn’t in a death spiral and repeating the claim, and citing markets with one or few carriers in the marketplace as evidence won’t make it so.

As a starting point, the very notion of a singular thing called Obamacare “collapsing” is conceptually flawed. “Obamacare” could collapse as a whole in theory, if it were designed much more haphazardly than it is. But the truth on the ground is nearly the opposite.

Obamacare isn’t one thing at all: It’s dozens and dozens of markets across the country, the compositions of which vary by region. Some of these markets are thriving, others are not; they are not collapsing en masse, and, thus, neither is Obamacare. To the contrary, the design of Obamacare makes it nearly death spiral-proof, because it insulates most consumers from premium increases, by linking subsidy levels to income and premium prices. Thus, even where single companies dominate, costs to consumers can be fairly stable.

The CBO does say that markets under AHCA would eventually stabilize, so it isn’t intellectually honest for people who don’t like Trumpcare to say Trumpcare will destroy insurance markets, just because we don’t want AHCA to pass. But the CBO also says that, under current law, “subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable.”

In other words, Obamacare isn’t “collapsing” or in a “death spiral,” and when Ryan, President Donald Trump and other Republicans say otherwise, as they often do unchallenged, they are lying.

3. Trumpcare is advancing through a normal process

Here, because the claim touches on process instead of substance, news media have done a better job pointing out how untruthful Ryan is being. “Regular order” doesn’t normally entail holding zero educational hearings, drafting legislation in secret, unveiling it to widespread criticism from industry and consumer stakeholders, then advancing it through committees, and the entire House of Representatives, before CBO has issued updated analysis. It especially doesn’t entail perpetrating a rush job like this for legislation that will have such far-reaching impact. But Republicans keep suggesting their process shines in contrast to the ones Democrats used to pass Obamacare, when the opposite is true and every honest journalist knows it.

4. Trumpcare will restore “patient-centered” care

This is focus-grouped pabulum conservatives use to describe all of their health care reform ideas, but it is particularly inapt vis-à-vis the American Health Care Act. The theoretical roots of the patient-centered care talking points lie in conservative opposition to government rationing in single-payer systems, where bureaucrats might decide not to reimburse physicians for certain treatment options. Like the equally dishonest “access to health care” spin Republicans use to describe a plan that leaves 24 million people uninsured, the “patient-centered care” conservatives dream of while drinking out of kegs is where doctors prescribe treatment regimens and people who can afford to pay for those regimens get them.

But that debate has nothing to do with the AHCA, which does basically nothing to change the regulatory foundation of the U.S. health insurance system. To the extent that the AHCA alters the doctor-patient relationship at all, it is by making it harder for women to obtain abortions. So, the opposite of what Ryan claims. But by and large, these are just nice-sounding words Ryan is tossing around to make a plan that will be a catastrophe for the poor and old and sick sound nice.


I have my own views about health care policy; and they color the way I think and write about the American Health Care Act. But shrill commentary isn’t necessarily misleading, just as politeness isn’t synonymous with honesty. Paul Ryan’s career, and his AHCA sales job, is testament to the latter point. Continuing to give him the benefit of the doubt will ruin countless lives.