Speaking to National Review editor Rich Lowry at an event hosted by the conservative magazine, House Speaker Paul Ryan made the case for the American Health Care Act by presenting it as a once-in-a-lifetime opportunity to cut Medicaid spending.
“We’ve been dreaming of this since I’ve been around,” Ryan says, before interrupting himself to clarify exactly how big of an opportunity this is, “since you and I were drinking out of kegs.”
AHCA’s Medicaid rollbacks would cost 14 million people their health insurance coverage, according to the Congressional Budget Office. But those 14 million people are people who only got Medicaid coverage relatively recently. Ryan’s youthful dream refers to provisions of the law that will cap per capita spending for the millions of other lower-income Americans who get Medicaid coverage.
Medicaid as it currently exists is already a very efficient health insurance provider, covering both children and adults at lower per capita costs than private insurance, so it’s very unlikely that Ryan’s per capita caps can be implemented without compromising the quality of the care.
Cutting spending on health care for children is particularly cruel, and will also have deleterious long-term consequences for the overall American economy. Studies of earlier waves of Medicaid expansion find that kids who gain coverage are more likely to complete high school and college, go on to earn more money and pay more taxes, and have fewer emergency room visits and hospitalizations later in life.
Undoing that sounds bad to me, but Ryan is passionate about the idea that the government helping low-income people can actually hurt them. As he explained during a 2014 speech to the Conservative Political Action Conference, social assistance programs make it less painful for people to be jobless.
“The left,” he said, “thinks this is a good thing. They say, ‘hey, this is a new freedom — the freedom not to work.’” But they’re “making a big mistake here. What they're offering people is a full stomach and an empty soul.” Under Ryan’s health bill, if you want your kids to get medical care then you’re going to have go out there and hustle and make sure you find yourself a better, more soul-filling job. And he’s been dreaming about that kind of soul-filling for a long time.