It is difficult to overstate how essential the peddling of outright lies was to the House GOP’s ability to pass the morally obscene American Health Care Act last week. Much has been made of the fact that Republican leaders railroaded their members into voting for an ink-wet bill that hadn’t been analyzed by the Congressional Budget Office, but one of the main reasons they did so was to make it easier to lie about what the legislation would do, rather than respond to what non-partisan experts say the bill would do.
Until Thursday, this was as much about convincing reluctant members to vote yes as it was about deceiving the public. With the bill now out of the House and in the Senate’s hands, the lies only serve the latter purpose. Top Republicans fanned out on the Sunday morning news shows, and rank-and-file Republicans returned to their districts, to mislead as many people as possible about what would happen if the AHCA became law.
It is unusual, perhaps unprecedented, for Congress to consider major social legislation that no one can sell honestly to the public. But it is also unusual for Congress to pillage money that provides health insurance to the poor and hand it to rich people and large corporations. To that end, these Republicans are counting on the reporters who interview them, and the news outlets that report on AHCA, to either not grasp finer points of health policy or to feel inhibited from disputing lies, so that the lies get transmitted to the public uncorrected. And these are the four lies they’ve decided are the most central to their sales pitch.
We’re Not Kicking Millions Off Of Medicaid
AHCA cuts Medicaid spending by hundreds of billions of dollars. A Congressional Budget Office analysis of an earlier version of the bill found that AHCA would reduce Medicaid rolls by five million people within a year, and 14 million people over 10 years. The Medicaid provisions have not changed since the publication of that impact estimate. This is the most consequential, black-is-white lie of the four, because it violates Donald Trump’s repeated campaign promise not to cut Medicaid and because of the degree of contempt it shows for millions of poor people. And House Speaker Paul Ryan echoed it on Sunday.
We’re Not Screwing Over Sick People
Ryan also claimed AHCA has “multiple layers of protections for people with pre-existing conditions,” when the truth is that the AHCA creates multiple hoops for people with pre-existing conditions to jump through in order to avoid massive price discrimination—and no guarantees that any insurance available on the market will be affordable to them, or provide them adequate coverage.
When Ryan says “you cannot be denied” he is hiding behind the technical fact that the AHCA continues to prohibit insurance companies from rejecting sick patients outright—a provision they kept precisely so they could make this misleading claim. But the Affordable Care Act’s pre-existing protections consist of two interlocking provisions: the “guaranteed issue” provision that ended the insurance company practice of telling sick patients to look elsewhere; and “community rating,” which pools risk across large geographic regions so that everyone in the same region of the same age pays the same premiums, for the same plans. Trumpcare ends the latter promise by allowing states to waive the community rating protection.
If sick people in those states experience a lapse in coverage (through job losses or other hardships) they will be subjected to underwriting—the process by which insurance companies make people disclose their health histories, so that they can charge people with illness more money. Sick people who could not afford market coverage would be able to enter underfunded “high risk pools” in those states, where coverage has historically been extremely poor. But even those who maintained continuous coverage would be susceptible to extreme price shocks. The AHCA encourages healthy people to forego coverage until they’re sick, or to choose underwritten health plans, in order to avoid the risk pooled market where they’d be cross-subsidizing sick people. What Ryan would call the first “layer of protection” for the sick actually has a hole in it that nearly all sick people in waiver states will fall through.
Because of this, House Majority Whip Steve Scalise felt he had to go on MSNBC Friday and dishonestly claim everyone with pre-existing conditions who currently has coverage will remain insured under the GOP plan.
We Didn’t End-Run the CBO At All!
Strong’s boss, Paul Ryan, repeated this basic claim on ABC’s This Week, and called claims to the contrary “a bogus attack from the left.”
The Congressional Budget Office estimates they are referring to were of versions of the bill that could not pass the House. Though they didn’t radically alter the basic structure of the bill, the changes Republicans have made to it since then were significant enough to make the bill acceptable to House Republicans. They include the provisions allowing states to waive both basic benefit requirements, so that insurance companies can sell junk plans, and community rating, so that insurance companies can price-gouge sick people.
House Republicans intentionally rushed their vote, and beat the CBO to the punch, to escape scrutiny for the implications of these changes. The prior estimates famously found the AHCA would kick 14 million people off their plans within a year, and leave 24 million extra people uninsured 10 years from now, relative to current law. Forthcoming estimates may not change those topline numbers much, but they will tell us a lot about how sick people will fare, and about whether the AHCA would put the federal government on the hook to subsidize scam health plans that cover basically nothing.
Health Insurance Doesn’t Save Lives Anyhow
Experts debate just how strongly having insurance correlates with mortality, but most believe tens of thousands of deaths each year are attributable to uninsurance. That’s a tiny fraction of the tens of millions of people who lack health insurance, but a catastrophically high number in absolute terms.
Conservatives cite uncertainty around the precise numbers to make sophistic claims, like the one Raul Labrador made on Friday, but this is not one of those instances where the counterintuitive argument is the correct one. People without insurance put off doctors visits, and stop taking expensive medicines, all the time. In some of these cases, such as undiagnosed cancer or worsening heart disease, the consequence of the delay is death.