Paul Ryan Reveals Why Republicans Have A Big Obamacare Repeal Problem

Jonathan Cohn

It sounded so easy, until taking away people's insurance became real.

Sometimes the most clarifying statements in politics are the ones that make no sense.

A case in point was something that House Speaker Paul Ryan (R-Wis.) said on Wednesday, during a press conference on Capitol Hill. The subject was Obamacare, which Republicans consider one of history’s great disasters, and their effort to repeal it quickly now that Donald Trump is about to become president.

More than 20 million people rely on the Affordable Care Act for health coverage. Repeal would leave most of them without insurance, unless a replacement is ready to go, and GOP leaders are nowhere close to creating one.

When a reporter asked Ryan about this on Wednesday, he reiterated a promise he and his allies have made before ― that Republicans would keep some of Obamacare’s elements in place, for a year or two or maybe longer, so that beneficiaries remain insured until Republicans can introduce a new system.

But Ryan’s phrasing this time was unintentionally revealing. He said, “We want to make sure there is an orderly transition so that the rug is not pulled out from under the families who are currently struggling under Obamacare while we bring relief.”

It’s a long, disjointed sentence because Ryan is trying to hit a bunch of different talking points. That’s what politicians do. But in this case, two of his arguments actually contradict one another.

With one breath, he’s saying that the people who have Obamacare insurance are “struggling.” With another, he’s saying that taking away their coverage would be like pulling a rug from under them.

Both things can’t be true. If Obamacare is as awful as Ryan says, then the people who stand to lose its insurance shouldn’t mind at all.

But many of them would clearly be upset. That makes repeal a lot more difficult ― and it’s why Republicans face such a quandary now.

There’s no question that millions of people don’t like how Obamacare has worked out for them. They are paying higher premiums, facing higher out-of-pocket costs, or dealing with more limited networks of providers, just as Ryan and the Republicans say.

The reason is that Obamacare rewrote the rules for selling insurance directly to individuals. Now, carriers must cover everybody, no matter how sick or old, and their policies must include a wide array of benefits ― including things like rehabilitative care, mental health, and maternity.

In effect, young and healthy people lost the preferential pricing they used to get ― and they can no longer find bare-bones policies that were available before. If Republicans scale back Obamacare’s requirements, or get rid of them altogether, many of the people paying more now will go back to paying less.

But there’s another group who clearly benefit from the new rules. It includes older and sicker people whom insurers traditionally turned down or who, at the very least, needed the full of array of medical services that policies frequently didn’t cover in the old days.

And then there are the millions who benefit from Obamacare’s tax credits to reduce their premiums, or who qualify for Medicaid in states that have expanded eligibility. Previously, many of these would have been uninsured.

Are all of these people thrilled with their coverage? No. But in surveys, Obamacare users tend to give the insurance decent or even high marks, depending on the focus and wording of the questions.

And it’s safe to assume most of the newly insured would prefer Obamacare coverage to what they’d get under (still mostly hypothetical) Republican alternatives, since the aggregate effect of GOP plans would be to provide less financial assistance, not more, and to leave people with serious health problems exposed to bigger medical bills.

Repealing Obamacare would create losers as well as winners, just like creating Obamacare did. As long as repeal was a talking point and not a realistic possibility, Republicans could ignore that possibility. Now they can’t. They don’t know what to do.

This is why some Republicans on Capitol Hill are sounding nervous ― and why Ryan suddenly isn’t making sense.

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