Ezra Klein wonders how Paul Ryan obtains $1.2 trillion in savings from repealing the Affordable Care Act if the Congressional Budget Office has previously scored the action as actually increasing the deficit by $210 billion. The answer, as Ryan himself explained at yesterday’s AEI speech, is that he repeals all of the coverage provisions, while maintaining the cuts to Medicare providers:
RYAN: We retain the Medicare savings and instead of double counting the Medicare savings…we end the raid of the Medicare program and we reapply those savings to Medicare to advance its solvency. Doing that, combined with eliminating all the Obama health care spending gets you the numbers I’m talking about. But we do repeal the IPAB.”
As Klein points out, this opens Ryan up to grave charges of hypocrisy because the GOP spent a lot of their time arguing that the Medicare cuts would 1) increase costs to the beneficiaries 2) were unsustainable and would drive providers out of the program. In fact, here is Ryan himself making this very point with CMS actuary Rick Foster earlier this year:
RYAN: Are you basically saying with a 10-year period, you believe that about 15% of Part A providers will stop taking Medicare or go bankrupt?
FOSTER: If nothing else happens other than they have these lower payment rates under the Affordable Care Act. [...]
RYAN: So basically what you’re saying is that not unlike what happened in the last decade, Congress went too far from the perspective of providers and took a lot of the savings back. And you’re basically suggesting that that’s probably the kind of pressure we’re going to face again?
FOSTER: Um, yes, the possibility is definitely there.
Providers, who went along with the cuts because they would have received 32 million new customers are already raising hell. “The coverage expansions are rescinded, but the cuts remain,” American Hospital Association President and CEO Rich Umbendstock told The Hill. “The two were coupled in healthcare reform… It’s unacceptable if just the cuts stand.”
“The combined effect of dropping the new coverage and maintaining the cuts threatens the care that communities depend on,” FAH President and CEO Chip Kahn said in a statement, “and will place harsh limits on the very health care providers who are frequently the most significant job creators in their local communities.”