"–The “death spiral.” At the town hall, Ryan reiterated the specious claim that because more unhealthy people are buying Obamacare plans and “healthy people [are] not buying it,” rates are “skyrocketing,” driving more healthy people away and leaving costly unhealthy customers in the pool in a vicious cycle.
Experts who have examined the ACA market say nothing of the kind is happening. The Council of Economic Advisers reported this month that there’s no evidence that premium increases have had an adverse effect on either enrollments in the individual market or the risk pool. Enrollment is rising, and signups of people in the 18-34 age range — the most desirable because most healthy category, have remained steady at about 28% of total enrollment. That’s not as high as the 40% share that would be required to make the pool totally self-sustaining, but it’s not declining either. And it contradicts Ryan’s claim that “younger, healthier people [are] just going without insurance.”
—What about replacement? Ryan was, typically, vague about what the Republican congressional majorities will propose to replace the ACA if it’s repealed. He said he didn’t want to get into “all of the legislative mumbo-jumbo,” but of course the nature of the replacement isn’t mumbo-jumbo to Obamacare beneficiaries — it’s their life-and-death concern.
One idea he did mention is expanding health savings accounts, which allow people to set aside tax exempt funds to pay for insurance. As we’ve mentioned before, HSA’s are giveaways to the rich and of limited use for lower-income people, who have trouble scraping together funds to put in an account and who won’t get much benefit from a tax exemption.
The most important question that Ryan dodged on Thursday, and again after Friday’s House vote, is what’s the rush? Repealing almost any part of the ACA will leave the individual insurance market in worse shape than it is now, and possibly worse than it was before the ACA. That’s especially true as long as no replacement plan is on the table. There are many routes to improving the Affordable Care Act without eroding public protections. If Ryan is truly intent on improving the lives of Americans dependent on the act, why does he have to shroud his intentions with misstatements and misrepresentations?"