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Trump's budget chief: Health insurance is 'not really the end goal'

Republicans know their health care plan isn't going to work, so they're moving the goalposts and adopting new metrics for success.
U.S. Rep. Mick Mulvaney, R-S.C., speaks at the Freedom Summit, Saturday, May 9, 2015, in Greenville, S.C. (Photo by Rainier Ehrhardt/AP)
U.S. Rep. Mick Mulvaney, R-S.C., speaks at the Freedom Summit, Saturday, May 9, 2015, in Greenville, S.C.
The architects of the new GOP health care plan have an amazing new perspective. "Republicans," Politico reported this morning, "say the plan's price tag and estimates of how many people it will cover aren't really important."Under normal circumstances, it's tempting to think these would be the first two questions Republicans would ask about any reform plan. Wondering how many Americans will have health insurance and how much the plan will cost aren't exactly obscure matters of policy minutiae, but as of this morning, GOP officials prefer to think of these metrics as trivia.Mick Mulvaney, Donald Trump's budget chief, added this morning that "insurance is not really the end goal here."No wonder Republicans are proceeding without a score from the Congressional Budget Office. They don't know what their bill will cost or how many millions of Americans will lose their health insurance -- and they plainly don't care.The effort to move the goalposts, ignoring meaningful metrics and making up new ones, is almost certainly a political necessity borne of the realization that the GOP's American Health Care Act isn't going to work as a matter of public policy. NBC News' Benjy Sarlin had a good piece on this earlier:

They rarely agree on much, but health care experts on the left, right and center of the political spectrum have found consensus on the House GOP's Obamacare replacement: It won't work.While their objections vary depending on their ideological goals, the newly introduced Affordable Health Care Act (AHCA) is facing an unrelenting wave of criticism. Some experts warn that the bill is flawed in ways that could unravel the individual insurance market.The bill, experts said, falls far short of the goals President Donald Trump laid out: Affordable coverage for everyone; lower deductibles and health care costs; better care; and zero cuts to Medicaid. Instead, the bill is almost certain to reduce overall coverage, result in deductibles increasing, and will phase out Obamacare's Medicaid expansion.

There's a reason Republican leaders are in such a rush to get their bill passed: the more time there is for scrutiny and analysis, the more "Trumpcare" looks like a cruel joke.A report from S&P, for example, found that between 6 million and 10 million Americans would lose their health coverage under the Republican blueprint. A separate Vox analysis considered the cost effects on consumers under the GOP model:

We're presenting an analysis here of the net financial impact of the Republican bill on premiums, after tax credits, plus cost-sharing. We estimate that the bill would increase costs for the average enrollee by $1,542, for the year, if the bill were in effect today. In 2020, the bill would increase costs for the average enrollee by $2,409.We provide the figure for 2020 because that's when the Republican tax credits would go into effect; we provide a figure for this year so that readers can get a sense of how the plan might affect their situation were it implemented today. Importantly, the gap between costs under the ACA and under the Republican bill would grow over time.In general, the impact of the Republican bill would be particularly severe for older individuals, ages 55 to 64. Their costs would increase by $5,269 if the bill went into effect today and by $6,971 in 2020. Individuals with income below 250 percent of the federal poverty line would see their costs increase by $2,945 today and by $4,061 in 2020.

As for private insurers, who've kept a fairly low profile in recent months, one CEO of a major insurance company told the Wall Street Journal that he'd expect to see "individual-plan premiums up by 30% or more next year" -- and even more still soon after -- under the Republican proposal.It's rare to see major legislative initiatives fail this badly as matters of politics and policy.