Speaker Paul Ryan (R-Wis.) faced some tough questions from audience members at a CNN town hall Thursday night, starting with a cancer patient who said ObamaCare saved his life.It was great TV, although I think Jeans started with the wrong question. (The right question is "Why would you replace Obamacare with something that's going to leave far more people like me without health insurance, according to all reliable reports?") Ryan, of course, insisted that there won't be repeal without a replacement in place -- we don't know whether that's true or whether Republicans are just saying that and hoping we'll forget that they said it when they do the opposite, or won't care -- and he went on to insist that the magic bullet for people like Jeans is government-funded high-risk pools.
Jeff Jeans said he was a lifelong Republican and small-business owner who had worked on the Reagan and Bush campaigns and was originally opposed to the Affordable Care Act.
But he said that at 49 he was diagnosed with cancer and given six weeks to live.
"Thanks to the Affordable Care Act, I’m standing here today alive," he said. "I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?"
At The Washington Post, Paul Waldman explains the problem with that, though not as clearly as he might have:
Ask any health policy expert about high-risk pools, and they’ll tell you that they’re absolutely the worst way to guarantee coverage for people with pre-existing conditions. Before the ACA, many states had them as a backstop for their most vulnerable patients. As this Kaiser Family Foundation report explains, they were characterized by high premiums, waiting lists to get on, lifetime and annual limits, temporary exclusions of the very conditions that made people seek them out (you often couldn’t get coverage for your condition in the first 6 or 12 months you were on the plan), and high deductibles.Your right-wing uncle would respond to this by saying that's a lot of liberal propaganda. So what else has Waldman got? How about some numbers?
In Paul Ryan’s plan, he suggests funding these high-risk pools with $2.5 billion per year. Tom Price’s plan is even stingier, at $1 billion a year. Those numbers are so low that it almost seems like a joke. This Commonwealth Fund study estimated that a national high-risk pool would require $178 billion a year to fund.Here's the problem, though: When Price (a Republican congressman who's Donald Trump's choice for Health and Human Services secretary) or Ryan proposes a number like $1 billion or $2.5 billion, it doesn't matter how stingy that actually is -- the average voter out there in the heartland is thinking, A billion dollars? Two and a half billion? Hey, that's a lot of money!
Republicans always take advantage of the fact that any dollar amount over, say, $1,000 (if we're talking about a government grant for an eccentric-sounding research project) can be made to seem like a huge outlay that really picks the pocket of Joe and Jane Lunchpail. Liberals can generate all the infographics and floor-of-Congress easel charts they want demonstrating that these proposals are woefully inadequate, and still much of America will think their cost sounds like a king's ransom.
The numbers in that Commonwealth Fund study aren't all that hard to explain. If a Republican plan were to cover as many of those who were priced out the pre-Obamacare insurance market by pre-existing conditions as Obamacare does, it would be covering 13.7 million people. If those people had an average of $20,000 in annual healthcare costs and paid $7,000 of that per year in premiums, that would leave $13,000 to be covered by this high-risk insurance. Multiply $13,000 by 13.7 million people and you get $178 billion. Ryan proposes to pay for less than 1% of that. Price has proposed to cover even less.
But it's likely that explaining this would make the average voter's eyes glaze over. Maybe it's making yours glaze over. Ryan and Price are proposing outlays that are very stingy but sound like really big numbers. And that will probably be enough to bamboozle America.