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Politics

Paul Ryan's Obamacare Repeal Fantasy

Even with Obama in the White House until 2017, the Wisconsin Republican's new budget relies on repealing most of the Affordable Care Act.

House Budget Committee Chairman Rep. Paul Ryan, R-Wis. leaves a Republican caucus on Capitol Hill in Washington, Tuesday, Jan. 1, 2013.  (AP Photo/Jacquelyn Martin)

photo of Jill Lawrence
March 11, 2013

Democratic reactions to Paul Ryan’s past budget proposals have run the gamut from skeptical to hostile to dismissive. Now add one more reason for all of the above: Even though President Obama won the 2012 election, Ryan's new plan to balance the federal budget in 10 years relies on repealing the Affordable Care Act.

The House Budget Committee chairman and former Republican vice presidential nominee aims to save hundreds of billions by turning Medicaid into a block grant and handing it off to the states. “By repealing Obamacare, and the Medicaid expansions which haven't occurred yet, we are basically preventing an explosion of a program that is already failing,” Ryan said on Fox News Sunday. He also would keep hundreds of billions in Medicare cuts that are already in the 2010 health care law (and which he and Mitt Romney fiercely attacked during the 2012 campaign), by repealing the law but keeping the cuts and using the money to help pay down the deficit. And presto, by the latest numbers available, you've got nearly $1.5 trillion in cuts right there from those two programs.

But that is a giant leap of faith, as Fox host Chris Wallace pointed out. For the health care law to be repealed before 2017, you’d have to believe that either Obama would, lamb-like, accept repeal of his signature domestic accomplishment, or that Republicans in 2014 would somehow win veto-proof two-thirds majorities in the House (290 votes if all 435 representatives are present, 58 more seats than the GOP held as of mid-March) and the Senate (67 votes, which would require a net gain of 22 seats).

 

For repeal to be feasible in 2017, a Republican would have to win the White House in 2016; Republicans would need to hold their House majority, and Republicans would need a filibuster-proof 60 seats in the Senate (15 more than they have now).

Just to put the numbers in perspective, in the huge GOP wave of 2010, the party picked up 63 House seats (the most since 1938) and six Senate seats (double the midterm average). So the gains they would need in 2014 and 2016 are not impossible, but they are a reach.

Beyond the statistics, 2017 is a long way off. By then, Obamacare will be woven into the fabric of the country and its health-care system, and it likely will have been tweaked to iron out problems as they arise. Millions of Americans will be buying private health insurance policies in online exchanges. Some of them are unable to buy coverage now because of preexisting conditions. Others who can’t afford it now will be getting federal subsidies. Private insurance companies won’t want to lose the new customers. Hospitals, now stuck with absorbing the cost of care for the uninsured, won’t want to lose the Medicaid expansion that will insure millions of poor and low-income people.

Backlash against the law is inevitable, but it’s equally if not more likely that Republicans would face public opposition to upending the system — from people who like the law, people who don’t want another huge battle, or people who don’t see the GOP suggesting anything better. So far at least, Republicans are following the same playbook as last year’s presidential campaign: pushing for repeal of “Obamacare” without proposing an alternative that would expand coverage to millions of uninsured and attempt to curb skyrocketing health care costs.

And how complicated would it be to keep the cuts in the Affordable Care Act, while scrapping the rest of it? Don't even ask.

But Ryan is undeterred by any of that.

“Are you saying that as part of your budget, you would repeal, you assume the repeal of Obamacare?” Wallace asked.

“Yes,” Ryan said.

“Well, that’s not going to happen,” Wallace said flatly.

“Well, we believe it should. That’s the point,” Ryan responded.

There are many aspects of Ryan’s past budgets that appear unrealistic or debatable, including their premises that Congress will agree to decimate safety-net programs and that huge tax cuts will generate more revenue instead of less. The continuing assumption that Obamacare will be repealed, even with Obama reinstalled in the White House, is just one more factor that makes Ryan’s budget more wishful than credible.

 

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