House Speaker Paul Ryan, R-Wis., said Sunday that he doesn’t know how many Americans would lose coverage under his proposal to revise the Affordable Care Act, which is under fire from fellow Republicans, AARP and virtually every sector of the U.S. health care industry.
“I can’t answer that question,” Ryan said in an appearance on CBS’ “Face the Nation.”
“It’s up to people,” he said. “Here’s the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country.”
Ryan’s answer focused on his proposal’s fulfillment of a long-standing Republican promise – to eliminate the individual mandate, which requires all Americans to carry health insurance and pay a penalty when they don’t. But he ducked the question of affordability, which is the cornerstone of most objections to the House Republican proposal to offer vastly less assistance to lower-income Americans than the insurance subsidies provided under the current law.
According to an analysis by S&P Global, the Ryan plan would lead to a loss of coverage for 2 million to 4 million Americans who have bought insurance policies under the law.
The speaker also seemed to contradict President Trump, whose promise to repeal and replace former President Obama’s signature domestic policy achievement has also come with a pledge that no one would lose health insurance coverage.
“It’s not our job to make people do something that they don’t want to do,” Ryan said. “It is our job to have a system where people can get universal access to affordable coverage if they choose to do so or not. That’s what we’re going to be accomplishing.”
Ryan’s interview came a day before the scheduled release of a new analysis from the Congressional Budget Office expected to show how many people would lose coverage under the American Health Care Act, as the Ryan plan is called – and at what cost to the government. He was one of nearly a half-dozen top Republican leaders deployed Sunday to defend the legislation against a barrage of criticism from within their own party.
“The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage.’ You know why? Because this isn’t a government mandate,” Ryan said.
Trump’s budget director, Mick Mulvaney, also defended the Ryan plan on the Sunday show circuit by trying to draw a distinction between “care” and “coverage.” He suggested that the new law would lead to better, more affordable health care for most Americans even if fewer of them carry insurance.
“That’s what we’re trying to fix,” Mulvaney said. “Not coverage for people, not coverage they can afford, but care they can afford. When they get sick, they can go to the doctor. That’s what the Donald Trump plan is working on, and that’s where we think it is going to be wildly successful.”
That premise contradicts data from the Kaiser Family Foundation showing that nearly a third of adults without insurance reported skipping doctor visits or other health services as a result of cost. The Centers for Disease Control and Prevention also identifies access to health services and insurance as one of five main influences of overall health.
In addition to trying to tamp worries about coverage, Ryan and his associates also attempted to quiet fresh warnings from conservatives that the bill could fail because it doesn’t go far enough to fully repeal the ACA.
“I wouldn’t say the reaction’s been awful,” Ryan said, rejecting the wording of a question from host John Dickerson. “Look. When you’re a governing party, getting consensus among your wide, big-tent party, not – everybody doesn’t get what they want.”
The health plan passed its first test last week, when Republicans on two House committees voted to approve the legislation. The next trial is expected Monday or Tuesday, with the nonpartisan CBO report; after that, the proposal heads to the House Budget Committee.
The public relations blitz caps a week of close collaboration between the White House and House leaders to calm Republican fears about the legislation. Trump invited more than a dozen lawmakers to White House meetings and West Wing lunches, and he dispatched Mulvaney, a former member of the conservative House Freedom Caucus, to woo his onetime colleagues.
Despite the charm offensive, a growing group of conservatives still threatened Sunday to kill Ryan’s long-promised plan unless Republican leaders agree to renegotiate some pieces of it.
“He will not have the votes,” Sen. Rand Paul, R-Ky., said Sunday on CBS’ “Face the Nation.” “Everybody is being nice to everybody because they want us to vote for this, but we’re not going to vote for it.”
Paul is one of as many as three dozen conservatives, including many members of the Freedom Caucus, to say in recent days that Ryan’s plan doesn’t go far enough in repealing the law. The group has branded the health bill as “Obamacare Lite” because Ryan plans to create a system of refundable tax credits to help people buy insurance on the private market.
Some conservatives also worry that Ryan is forcibly rushing votes on legislation that could cost Republicans dearly in upcoming elections. They say the plan risks angering the voters who demanded a full repeal of the ACA as well as those who could lose insurance once the new reforms are put in place.
“I believe it would have adverse consequences for millions of Americans, and it wouldn’t deliver on our promises to reduce the cost of health insurance for Americans,” said Sen. Tom Cotton, R-Ark., on ABC’s “This Week.” “I would say to my friends in the House of Representatives with whom I serve: ‘Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote.'”
Democrats are ready to exploit any weakness the infighting may create. On Tuesday, House Minority Leader Nancy Pelosi, D-Calif., is scheduled speak at a rally on Capitol Hill to protest Republican plans to end ACA programs, including an expansion of Medicaid coverage to more than 20 million people in 31 states.
That message could have a particularly damaging effect if Monday’s CBO estimate proves their case. Many moderate Republicans – both in Congress, in governor’s mansions and in state legislatures – have already shared their concerns that millions of people could lose their insurance under the plan and premiums could spike for those who continue to buy private coverage.
Ohio Gov. John Kasich is one of more than a dozen Republican governors serving in states that have accepted the Medicaid expansion provided under the ACA.
“If chronically ill, you’re going to have to have consistent coverage,” Kasich said Sunday on NBC’s “Meet the Press.” “Under this bill you don’t have it.”
Mulvaney set out Sunday to get ahead of fears that the CBO score will prove Kasich’s fears by questioning the trustworthiness of the nonpartisan agency.
“We continue to think, and have for a long time, that the CBO was scoring the wrong thing,” Mulvaney said. “They’re scoring Obamacare as it exists today, not tomorrow. Obamacare is this close from completely collapsing.”
Ryan and Tom Price, Trump’s health and human services secretary, also repeated Mulvaney’s promise that the legislation would provide people access to coverage, not coverage itself.
“What we can promise is we’re going to replace it with a better system so we have more insurers, more choices, more competition, prices go down,” Ryan said. “We give people the ability to go access affordable coverage.”
Price also said Sunday on NBC’s “Meet the Press” that his definition of success for the health plan would be for insurance costs to go down so more people could buy coverage without federal assistance.
“Success, it’s important to look at that, and it means more people covered than are covered right now at an average cost that is less, and I believe we can firmly do that with the plan that’s laid out there right now.” Price said. “I firmly believe that nobody will be worse off financially.”