Rep. Paul Ryan (R-WI) is now the second Republican this week to criticize Mitt Romney’s Massachusetts health care reform plan…and it’s only Wednesday. Speaking at a breakfast sponsored by the American Spectator, Ryan followed up on Gov. Haley Barbour’s (R-MS) criticism yesterday and said that Romney’s proposal is “not that dissimilar to Obamacare. And you probably know that I’m not a big fan of ObamaCare.” Phil Klein has the details:
“I just don’t think the mandates work,” Ryan said. “I haven’t studied in depth the status of it, but I think it’s beginning to death spiral, they’re beginning to have to look at rationing decisions. I don’t think this kind of a system works.”
By “death spiral” Ryan is referring to the phenomenon that occurs when government require insurers to cover those with pre-existing conditions, which discourages healthy people from buying insurance because they know they can always find coverage when they get sick, which in turn drives up the cost of insurance even more, and causes more healthy people to exit the market, and so on. This is what the individual mandate is supposed to prevent, but Ryan, like other health policy analysts is a skeptic that it works in practice.
Ryan went on, “That’s why I’m a believer in a consumer-based patient centered health care reforms, and I don’t think that the Massachusetts plan does it, it goes in the opposite direction.”
Ryan’s remarks comes just two days after President Obama said he agreed with Romney’s health care plan. “In fact, I agree with Mitt Romney, who recently said he’s proud of what he accomplished on health care in Massachusetts and supports giving states the power to determine their own health care solutions,” Obama said in an address to the National Governor’s Association. At that event, Obama touted a new measure that would give states more flexibility in how they design their universal health care programs, a position Romney himself has previously embraced. (Romney has defended his reform plan, but argued that states should develop their own health care solutions.)
Similarities aside, Republicans who reject both plans’ individual mandate will have a difficult time proving that the provision has failed to expand access to insurance. Today, more than 98 percent of Massachusetts residents have health care coverage, including 99.8 percent of children — the highest in the nation. The percent of private companies offering health insurance to their employees has also increased from 70 to 76 percent and in 2011, the state spent $405 million on uncompensated care, nearly $300 million less than before reform was enacted in 2006.
Still, because Romney’s reform plan addressed access without tackling costs, the state is considering various proposals to lower health care spending. Gov. Deval Patrick (D) has introduced what he calls “the second phase of health care reform” to develop new mechanisms for delivering and paying for health care. But that has nothing to do with the “death spiral” or “rationing” that Ryan is so worried about; rather it’s the next step in developing and improving Romney’s very popular health care plan.
Jonathan Cohn points to this study from the Urban Institute which debunks the rationing argument:
According to a study that two Urban Institute researchers published this spring, the number of working-age adults reporting that they skipped care because of high costs fell from 17 percent to 11 percent in the first two years after the law took effect. The gap was even more dramatic among those eligible for subsidized insurance through the Connector–that is, people making less than three times the poverty line, or around $66,000 per year for a family of four. Among those people, the proportion skipping care because of cost fell from 27 percent to 17 percent. And that’s despite a rough leveling-off in the second year, most likely due to the fact that the recession meant lots of people were out of work and counting their pennies. When the economy rebounds, the number should decline even more.