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Paul Ryan On $800B Medicaid Cut: 'I Hardly Think That's Draconian'

Even if you understand the topic, Paul Ryan's "explanations" will make your head hurt.
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I wrote this post about Medicaid back in December, and it's held up pretty well:

Naturally, Republicans want to kill it. But being Republicans, they can’t come out and tell you what they’re doing. So they want to replace Medicaid with block grants, grants that will be announced as slightly more than current costs! And it will allow innovation! And efficiencies! Isn’t that great? Aren’t Republicans swell?

Really, you bought that? I assumed you would know better by now, but apparently not. Here’s the catch: The Baby Boomers are starting to die off. (Just look at 2016!) Block grants are a shell game used by Republican con men, a way of pretending to fund something that will never keep up with the necessary demand. Block grants are like concert tickets. If you don’t snag a place in line by the time the annual funding runs out, you’re out of luck.

And here's Paul Ryan proving my point when he appeared on This Week yesterday, spouting an impressive array of doublespeak, obfuscation, and plain old gibberish.

George Stephanopoulos starts off by pointing out that the Republicans are doing everything they accused Democrats of doing during the ACA fight. They passed it without a CBO score, and many of them voted for it without reading the bill.

Ryan responded by calling it a "bogus attack from the left." He said the bill has been online "for two months." Stephanopoulos said it was not the final version.

Ryan said the final version was an amendment that was three pages long. "This bill is under 200 pages. It doesn't take long to go through this bill, and the final amendment -- three pages long." He insisted the amendment didn't "dramatically alter" the CBO score.

Stephanopoulos retorted that members who changed their vote said there were "quite significant changes to the bill. A change to the essential benefits." He said the amendment added money, too.

RYAN: The last one was -- yes. The last -- it's called the Upton Law and several other members wanted this amendment.


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We looked at the whole country and we wanted to see is there a situation, under any situation, with the state getting a waiver, if there is a person that could get charged higher health care costs because of their health status, because of preexisting condition? We looked and decided there might be a situation where, within the course of one year, a person could conceivably get higher health care costs. This amendment affects that.

So we have all these multiple layers of protection to make sure that these families, that these people -- look, these are our friends and our constituents. We will want to make sure people who have bad health care status, who have a preexisting condition, get affordable coverage. And that's not happening in Obamacare. You got to remember, if you can't even get a health insurance plan, what good is it? You don't have health insurance.

So what we're trying to do here is have a system where we have more choices, more competition, and lower prices. And yes, this CBO score does say it lowers premiums. The goal here is two things: Get premiums down, get -- and give people choices. And make sure that people with preexisting conditions get coverage. And we have multiple layers of this.

But the CBO analysis says that, over ten years, 24 million people lose their coverage, Stephanopoulos said. He said deductibles will go up, and that for many Americans who are just short of Medicare, 55-64 years old, "particularly in rural areas, they're going to be paying thousands more in premiums every single year. The AARP calls that an age tax."

"So if you accept one part of the CBO analysis, do you accept the other part of the CBO analysis as well?"

Here's where the doublespeak gets really interesting.

"What the CBO is basically saying, and I agree with this, if the government's not going to force somebody to buy something they don't want to buy, then they're not going to buy it. So they're basically saying people, through their own free choice, if they're not mandated to buy something that's unaffordable, they're not going to do it. So under this bill, everybody's going to get a refundable tax credit to buy a plan of their choosing," Ryan said.

He went on to say "young, healthy people" are not paying for this "unaffordable" insurance.

"And that's one of the biggest reasons why Obamacare is collapsing and insurers are losing money and pulling out of the marketplace."

Ryan says the Senate will be adding a "much larger tax credit" for people who are 50 and older. (If there was a thought balloon, you could see him thinking. "This is Mitch's problem now.")

"But we have this one-size-fits-all rule from Obamacare that is crashing. It's why insurers are pulling out, people are getting no choices, and premiums are skyrocketing. Premiums went up 116 percent in Arizona in this year alone." (Nothing to do with Republicans defunding parts of the law meant to stabilize the market, nope.)

"People want the peace of mind of knowing they can get affordable coverage, especially for people with preexisting conditions. And quite frankly, George, that's what we're achieving here."

Stephanopoulos noted that a lot of people "think it will be worse."

He pointed out the bill cuts taxes "by about $900 billion. It cuts Medicaid and other subsidies by about $1 trillion. I want to put a chart right now that shows the distribution of those benefits and burdens right now. And it shows that just about everybody under $50,000 is going to be cut back, small benefits for the middle class above that, but a huge, huge benefit for those making over $200,000 a year.

Warren Buffett just yesterday said he's going to get a 17 percent tax cut. And your critics are saying this is just a huge transfer of wealth from the poor and middle class to the wealthy."

Ryan called the Obamacare taxes "job killing taxes that hurt economic growth" and "make health insurance more expensive."

But most of benefits go to millionaires, Stephanopoulos said.

Ryan said the GOP wants to "give the states the ability to customize the Medicaid program to work for their particular states."

Stephanopoulos addresses the elephant in the room: "You're saying they can do that with $880 billion less." And that's when the real manure storm begins.

RYAN: We're -- we're giving states the ability to run their own Medicaid program. And it is increasing for medical inflation.... By giving states the right to run Medicaid, and giving them a block grant, per capita block grant, or a block grant, and then increasing that the spending by medical inflation, I hardly think that's draconian.

"So you don't think anyone will be hurt when you're taking $880 billion out of the system?" Stephanopoulos said again.

And what does Ryan say? The equivalent of the old "waste, fraud and abuse" routine. He implies there is a corresponding amount of money that can be cut due to "micro-management of Medicaid by the federal government."

"Again, George, here is the fatal conceit of Obamacare, it says we're going to micromanage this with bureaucrats with Washington telling every state and every community how it must work. That is failing. Medicaid is not working. Obamacare is collapsing. Insurance plans are pulling out. People are not getting no choices, if any at all. And we have to fix this."

How many people will buy Ryan's explanations? Stay tuned for 2018.

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