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Paul Ryan faces (and flunks) health care test

A voter whose life was saved by the ACA challenged House Speaker Paul Ryan at a town-hall forum. Ryan responded with claims that were plainly wrong.
House Speaker Paul Ryan speaks during a news conference on Capitol Hill in Washington, June 23, 2016. (Photo by Yuri Gripas/Reuters)
House Speaker Paul Ryan speaks during a news conference on Capitol Hill in Washington, June 23, 2016.
Early on in House Speaker Paul Ryan's (R-Wis.) town-hall event last night, the congressman fielded a question from a voter who seemed like an ally. The man, who owns a small business in a red state, explained that he had worked for the Reagan and Bush campaigns, and he opposed the Affordable Care Act.At least, he used to. This same man explained that he faced a life-threatening form of cancer, which was treated because he had coverage through the Affordable Care Act. "I want to thank President Obama from the bottom of my heart," the man said, "because I would be dead if it weren't for him."It was a timely reminder that Paul Ryan's repeal crusade, which has already run into some trouble in Washington, probably won't be as easy as the far-right House Speaker hoped.The man whose life was saved by the ACA specifically challenged Ryan on the Republican replacement. The Speaker said what he was expected to say -- he intends to replace the law with "something better" -- but Ryan went on to point to a specific concern he has with the status quo. From the CNN transcript:

"The problem with Obamacare -- the actuary is called a 'death spiral.' It's a really kind of ugly, gruesome term, but a 'death spiral' is a mathematical term. They say when the insurance gets so expensive, healthy people won't buy it because they -- it's just a trade-off. The penalty to not buy is a lot cheaper than buying the insurance, so healthy people won't buy it; therefore, they won't go and participate in the insurance pool to cover the losses that sicker people, who have to have insurance, buy it."That's what's happening to Obamacare now."

No, it's not. This isn't a matter of opinion; it's a matter of reality. If the Speaker of the House is going to hold forums like these, and speak to national audiences about the state of the health care system, it's important that he tell the public the truth.And the truth is, if the ACA were in "death spiral," we'd see declining enrollment numbers, with consumers withdrawing from the system because they can't afford the premiums and would rather pay the penalty than buy insurance they can't afford.Enrollment totals, however, are going up, not down.Despite higher premiums in parts of the country, and against a political backdrop in which Republicans are desperate to destroy the existing system, Americans are getting health care coverage through the ACA in growing numbers: we learned just this week that 11.5 million consumers bought marketplace plans in 2016, an increase of nearly 300,000 over the comparable period last year.If Ryan and his GOP allies were counting on an anti-Obamacare campaign to discourage the public from buying coverage, it's not working. A New York Times report added this week:

The proportion of young adults signing up has held steady, a sign that the mix of people buying insurance this year is unlikely to be substantially sicker and more expensive than the people enrolled in plans last year."Today's data show that this market is not merely stable, it is actually on track for growth," Aviva Aron-Dine, a senior counselor to Sylvia Mathews Burwell, the secretary of Health and Human Services, said in a conference call with reporters. "Today we can officially proclaim these death spiral claims dead."

Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, added in an interview with the Huffington Post, "It seems to me that enrollment holding steady amidst tremendous uncertainty about the future of the law and big premium increases is a positive sign. There is no evidence of a market collapse or insurance death spiral."In other words, what Ryan said last night was largely the opposite of the truth. Pundits who are too easily dazzled with the Speaker's ability to speak in complete sentences overlooked the fact that he's plainly wrong about the substance.