He didn’t. Instead, he and his allies crafted a poorly constructed and radical bill that would sharply cut support to low-income Americans and those with serious health conditions, while enacting big tax cuts for the wealthy. The payout to the top 400 families alone was estimated to exceed total ACA subsidies in 20 states and the District of Columbia. All of this was wildly out of step with American voters—only 17 percent of whom supported this bill.
Every liberal and conservative think tank hated AHCA, albeit for different reasons. Medical provider groups hated it. The AARP hated it—even before the Congressional Budget Office estimated that 64-year-olds with $26,500 annual incomes would see their average net individual insurance premiums go from $1,700 to a $14,600. Republicans tried to patch this up. Too late. This 760 percent premium increase was politically immolating.
This was a baffling error. Everyone in health policy knew this assessment was coming. Did Speaker Ryan or the White House run these numbers? If not, did they understand their own legislation? If so, did they simply hope that no one would find out? Ryan’s spin of the CBO report—that it vindicated his argument that the AHCA would drive down costs—was laughable. The real takeaway was that 24 million fewer Americans would be insured, and those that remained would see their premiums increase as their coverage worsened.
What’s so baffling about Ryan’s failure is that he knows as well as anybody that social entitlements are devilishly hard to take away—because people like them.