Why RyanCare Is Not Like ObamaCare

Since the GOP has endorsed Rep. Paul Ryan’s (R-WI) plan to completely privatize Medicare by 2022, some Republicans have abandoned their claim that the Affordable Care Act would lead to single payer government health care and begun arguing that Ryan’s reforms are very similar to the exchange structure in the ACA. “It’s exactly like Obamacare,” said NRSC chairman Sen. John Cornyn (R-TX) in the Capitol several weeks ago. “It is. It’s exactly like it. Which strikes me as bizarre that you’re seeing so much pushback [from Democrats].” TPM’s Brian Beutler points out that House Speaker John Boehner (R-OH) is now making the same argument:

According to Speaker John Boehner, the House Republican budget, which passed on April 15, “transforms Medicare into a plan that’s very similar to the President’s own healthcare bill.”

That’s from an interview with ABC’s Jon Karl. Boehner joins Sen. John Cornyn (R-TX) as one of the few high-profile elected Republicans who will admit that the GOP’s Medicare privatization plan is similar in many key respects to the health care law they have spent the last two years demonizing.

But this isn’t quite right. The Ryan plan — particularly the new Medicare exchange of private plans that becomes operational in 2022 — may structurally resemble the exchanges established by the Affordable Care Act in 2014, but in Obama’s plan the subsidy would not depreciate over time and the exchanges themselves will likely provide more choice and be better regulated than anything the free-market obsessed GOP is envisioning. For instance, Ryan has already said that Americans under 55 will no longer have the choice of enrolling in traditional fee-for-service Medicare and has not yet indicated if — like the ACA — seniors in rural districts will have a guaranteed choice of insurers.

The biggest difference between Ryan’s framework and Obama’s plan is that Ryan would take away coverage and increase costs, while Obama would expand insurance rates and lower personal spending. Under the Affordable Care Act, individuals and families who can’t find affordable insurance in the existing individual market — because they have some chronic condition that insurers don’t think would be very profitable — would finally have a stable source of comprehensive insurance, receive subsidies to help make it more affordable and see limits on annual out-of-pocket spending. Obama also institutes some key delivery reforms to help bring down the overall costs of care.

Ryan, on the other hand, would take seniors out of a single-payer health care system that keeps administrative costs at around two percent and force them to purchase those same benefits, at a higher price, from private insurers with significantly higher administrative spending. Seniors will, as the Congressional Budget Office put it, “spend more for health care,” particularly as their $8,000 voucher fails to keep up with health care costs (even if it is adjusted for income and health status, seniors would still receive less value than the existing Medicare system).

So while it’s a hoot to see the Republicans finally endorsing the Affordable Care Act — they should stop comparing it to the Ryan plan and quit trying to repeal it.