Republicans have plenty of criticisms for the Affordable Care Act, and some of their points are more credible than others, but of all the arguments GOP officials are pushing aggressively, I think we've identified the worst.
Yesterday afternoon, for example, Donald Trump's White House published a curious tweet:
FACT: when #Obamacare was signed, CBO estimated that 23M would be covered in 2017. They were off by 100%. Only 10.3M people are covered.
I realize the White House's communications office is struggling right now -- the communications director recently quit after a few months on the job, and no one wants to replace him -- but someone over there probably should've read this before publishing it. If the Congressional Budget Office projected that the ACA would cover 23 million Americans, and the CBO was "off by 100%," that means it would've been off by 23 million -- because 100% of 23 million is 23 million. According to the White House's own message, that's not what happened.
Worse, by claiming that "only" 10.3 million Americans have gained coverage through the ACA, Trump World has cut the actual number roughly in half (though it is a nice change of pace for Republicans to acknowledge that the ACA has brought coverage to millions, even if the White House's numbers are all wrong). The figure only includes consumers who've bought insurance through exchange marketplaces, and ignores others who've gained coverage through the law.
But the underlying point of the tweet is that coverage levels matter. If you want to evaluate a health care blueprint, the argument goes, then take seriously how many Americans are insured under that system.
Senate Majority Whip John Cornyn (R-Texas), in a message apparently intended to serve as criticism of the ACA, added yesterday, "28 million uninsured under Obamacare." The White House has been pushing this data point, too.
It's baffling to see Republicans push this argument because it makes their own side look so much worse.
Yes, in reality, the Congressional Budget Office has found that under the Affordable Care Act, there are still 28 million uninsured Americans. If Team Trump and John Cornyn believe that number is too high, then we're all on the same page.
Of course, that number would be much lower if Republican governors had adopted Medicaid expansion through the ACA -- in other words, the 28 million figure is partly a failure of GOP governance, not "Obamacare" as a model -- but federal officials can't force those state officials to do the right thing.
The Congressional Budget Office also found, however, that the Republican alternative to the ACA would make this problem vastly worse, forcing 22 million Americans into the ranks of the uninsured.
There was a point a few months ago in which some Republicans tried to make the case that the uninsured rate wasn't all that important. GOP officials, the argument went, were focused on costs and access, not whether Americans were insured or not. This wasn't an especially good argument -- no one ever seemed able to explain what "access" meant, exactly -- but it at least reflected a baseline understanding of reality. When it came to providing health security to U.S. families, Republicans were going to pursue an approach that fell far short of the Affordable Care Act. They knew that in advance, and tried accordingly to establish certain parameters for the debate that would favor their side.
But more recently, for reasons that defy comprehension, Republicans have gone in the opposite direction. The number of uninsured does matter, they've decided. As the debate proceeds, let's focus on that, they've argued.
To which health care advocates and other critics of the GOP plan have responded, "Great idea."
There is no sensible explanation for such an approach. Leading Republican officials have decided to argue, in all seriousness, that they see 28 million uninsured as a problem that they're desperate to make worse. As we joked the other day, GOP leaders have found a simmering fire that they hoped to put out with a flamethrower.
The Republican line isn't just wrong; it's gibberish. The party should be genuinely embarrassed by their own nonsense.