More Paul Ryan deception on health care

Or, it's a day that ends in -y and Paul Ryan opened his mouth

by folkbum

About the only thing nice I can say about Paul Ryan's repeated insistence on writing about the health care bill just passed is that, bless him, he is one of the last of us who insist on spelling health care as two words, the way FSM intended it to be.

Aside from that, there is basically nothing to recommend in his latest op-ed fantasy. His starting point is the recently released Health and Human Services/ Center for Medicare and Medicaid Services report. Thankfully, Ryan does not repeat the fiction--one that ricocheted around the righty blogs last week--that the Obama administration buried the report. Such a claim is embarrassing to contemplate spreading, seeing as how there is nothing in the report that wasn't already widely known. The Congressional Budget Office told us all in its scoring of the bill back in March that total health care spending with the bill passed would be greater than total health care spending without the bill being passed. The CMS report says the same thing, and Ryan is hyperventilating like it's something new to panic about. Here's Ryan:

The health care law will increase national health expenditures by an additional $311 billion above current projections. This estimate refutes the Majority’s promise that the legislation would bend the cost curve down, not up.

Ryan is being misleadingly cynical in the most charitable interpretation--outright lying if I'm being less kind. For starters, this is pretty simple math: The Affordable Care Act adds about 34 million more people to the ranks of the insured, and according to both the CBO and CMS, total health care spending will increase about 1%. Got that? We're adding 12% of the population to the rolls at a cost of not 12% more, or even 8% more, but just 1% more. And that is total spending including the private sector, not merely government spending. Ezra Klein, please:

And that 1 percent is actually 1 percent and falling: When the legislation is fully implemented in 2016, the spending increase will be 2 percent. But cost controls kick in over those years and bring it down to 1 percent. Assuming the trend holds, the second decade will see national health expenditures fall below what spending would've been if the bill hadn't passed. So that's the bottom line of the report: We're covering 34 million people and come 2019, spending is expected to be one percentage point--and falling--above what it would've been if we'd done nothing.

Or, as actual actuary Jim Lynch (via) noted the other day: "I really don’t see where anyone can claim the actuaries’ report sheds new light on the health care legislation passed this year. And what is new is slightly favorable to Obamacare, not the other way around." In other words, the CMS report that Paul Ryan is whining about, no matter how you slice it, is good news for reform advocates, and bad news for naysayers like Ryan.

(The graph comes from a different Ezra Klein post, but I hope you can see how ridiculous Ryan's whining about increased costs actually is. Click for a bigger version, or follow that link.)

Here's lyin' Paul Ryan a couple paragraphs later:

Approximately 14 million people will be dropped from employer coverage as “…the per-worker penalties assessed on nonparticipating employers are relative low compared to prevailing health insurance costs. As a result, the penalties would not be a substantial deterrent to dropping or forgoing coverage.”

Now, if you're an average Racine Journal Times reader who comes across this line, what do you think it means? Do you think it means that the ranks of the uninsured will swell by 14 million people? Or at least that 14 million fewer people will be getting health insurance through their jobs than without the bill having been passed? That's a reasonable answer, based on what Paul Ryan gave you here. But remember, this is Paul Ryan we're talking about, so he's lying to you again. Let me quote some more from the CMS study, the same paragraph even, that Ryan quotes from (page 7 for those of you following along at home--my emphasis):

By 2019, an estimated 13 million workers and family members would become newly covered as a result of additional employers offering health coverage, a greater proportion of workers enrolling in employer plans, and an extension of dependent coverage up to age 26. However, a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchanges. For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries might find it to their—and their employees’—advantage to end their plans, thereby allowing their workers to qualify for heavily subsidized coverage through the Exchanges. Somewhat similarly, many part-time workers could obtain coverage more inexpensively through the Exchanges or by enrolling in the expanded Medicaid program. Finally, as noted previously, the per-worker penalties assessed on nonparticipating employers are very low compared to prevailing health insurance costs. As a result, the penalties would not be a significant deterrent to dropping or forgoing coverage. We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about 17 million, or somewhat more than the number newly covered through existing and new employer plans under the PPACA. As indicated in table 2, the total number of persons with employer coverage in 2019 is estimated to be 4 million lower under the reform package than under current law.

So when Ryan wants you to think the ACA means 14 million fewer people with employer-paid insurance, he's actually off by a full ten million people.

(And I am not even going to bother going into how wrong Ryan is on Medicare Advantage--if he wants to use the CBO to bash the ACA he should be using the CBO to bash Medicare Advantage, too. That's only fair, right?)

I have said it before and I will say it again now: I do not understand how someone who is so brazen, so brash, so sloppy in his representation of the facts continues to be lauded and taken seriously by people, particularly the media. How is it that the Journal Times can let all of this go without a fact check or a rebuttal by someone more firmly rooted in reality. Paul Ryan is unashamedly lying to his constituents, over and over and over again.