“We always know, you’re never going to win a coverage beauty contest when it’s free market versus government mandates,” Ryan told radio host Hugh Hewitt, after Hewitt floated the possibility that the CBO would estimate 15 million people will lose health insurance because of the American Health Care Act.
He was referring in part to the Obamacare's mandate that individuals purchase insurance, and the tax penalties it imposes on those who don't. But the law also provides more government assistance to buy care than the Republicans' alternative, which provides tax credits based mostly on age.
“If the government says, ‘Thou shall buy our health insurance,’ the government estimates are going to say people will comply and it will happen. And when you replace that with, ‘We’re going to have a free market and you buy what you want to buy,’ they’re going to say not nearly as many people are going to do that,” Ryan continued. “That’s just going to happen. And so you’ll have those coverage estimates. We assume that’s going to happen. That’s not our goal. Our goal is not to show a pretty piece of paper that says, ‘We’re mandating great things for Americans.’
“We’re not going to get into a bidding war with the left about how much we can mandate, or put entitlements out there for people,” he said later.
Paul isn’t the first to discredit the CBO’s coverage estimates as a legitimate measure of the success of health care legislation.
The director of the Office of Management said Wednesday that “insurance is not really the end goal here.”
“So we’re choosing instead to look at what we think is more important to ordinary people: Can they afford to go to the doctor?” he added later.
And Health and Human Services Secretary Tom Price, the White House’s point person on the legislation, granted later that day that it was the legislation’s “goal” to provide insurance for all at a lower cost – Trump’s promise of the bill – but said the priority was cost.
“I would suggest to Martha that what our desire is, is to make sure certain you are the individual that is able to select the physician and the treatment that you desire for yourself, not that the government dictates to you,” Price said, responding to a woman who stood to lose thousands of dollars in government health care subsidies.
In his interview with Hewitt, Ryan also agreed that the ACHA’s eventual capping of Medicaid was the largest change to federal entitlements in his lifetime.
“We’re talking about hundreds of billions of dollars a year,” he said. “This is so much bigger, by orders of magnitude, than [the] welfare reform [of 1996].”