Paul Ryan and President Trump have been insisting for months that Obamacare is collapsing, failing, imploding, spiraling quickly into death. This is ridiculous, of course. It's covering more than 20 million people at a lower cost than originally projected, and by any fair appraisal it's been hugely successful.

But that's not to say it has no problems. The Obamacare insurance pool is skewed toward the old and sick, and this has made it hard for insurers to turn a profit. Several smallish insurers have already left the market, and there are hundreds of counties in the US with only one insurer left on the exchanges. This is probably not fatal—CBO says the Obamacare market is stable—and it's a problem that could be addressed fairly easily and inexpensively. Still, it does put the Obamacare market in modestly perilous shape.

But what happens next? Even if the godawful Republican repeal effort fails, there's every reason to think that Congress will try again. What's more, it's clear that they'll do everything they can to undermine Obamacare along the way. In a few months, insurance companies have to decide whether they want to participate in the exchange market in 2018, and I wonder what they'll decide? The uncertainty is sky high now, and that means they have little incentive to continue. Remember, most insurers swallowed big losses early on in hopes of building a stable, profitable market later. But what's the point of absorbing losses if it looks like—at best—years and years of chaos ahead?

It may be that 2018 is safe. The exchanges are pretty close to profitable now, and it's probably worth it for most insurers to stay on board for at least another year to see what happens. Still, I wonder. Merely by upending everything and making it clear just how dedicated they are to cutting taxes on the rich and cutting health coverage for the poor, have Republicans already managed to effectively repeal Obamacare without passing a single page of legislation?

Hear me out. Today Breitbart News published an audio recording of Paul Ryan disowning Donald Trump during the campaign:

In the Oct. 10, 2016 call, from right after the Access Hollywood tape of Trump was leaked in the weeks leading up to the election, Ryan does not specify that he will never defend Trump on just the Access Hollywood tape—he says clearly he is done with Trump altogether.

"I am not going to defend Donald Trump—not now, not in the future," Ryan says in the audio, obtained by Breitbart News and published here for the first time ever.

This isn't really big news. We pretty much knew this was what Ryan said back when he said it. But apparently Breitbart has been holding onto this recording until the time came when they could get the maximum mileage from giving Ryan's remarks another news cycle. That turned out to be today, right after the Congressional Budget Office had released a devastating report on Ryan's health care bill.

Then, a few hours later, someone in the White House leaked an internal analysis that says Ryan's bill is even worse than the CBO says it is—quite a feat, given that the CBO trashed the bill pretty comprehensively.

We know that Breitbart and Steve Bannon have long loathed Paul Ryan. So…maybe this was all orchestrated by Bannon? Wait for the CBO wrecking crew to come through, and then release both an embarrassing audiotape of Ryan and an embarrassing White House analysis that confirms just how bad Ryan's bill is.

Was Trump in on this—waiting until just the right moment to take his revenge on Ryan for insufficient loyalty during the campaign? Or is this Bannon acting on his own? Or just a coincidence? I'm not sure. But one way or another, it sure seems like a coordinated effort to doom Ryan's bill and wreck his reputation with his own caucus.

My brain is imploding. HHS Secretary Tom Price said today that CBO's estimate of insurance losses under the Republican health care bill "defy logic." But it turns out the White House—which Price works for—agrees with the CBO. In fact, they think CBO is a little too optimistic. Here is Politico:

The White House's own internal analysis of the GOP plan to repeal and replace Obamacare show even steeper coverage losses than the projections by the Congressional Budget Office, according to a document viewed by Politico on Monday.

The executive branch analysis forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimate — a finding that undermines White House efforts to discredit the forecasts from the nonpartisan CBO.'s doesn't'''s...I mean...WHAT THE FUCKITY FUCKING FUCK-ALL FUCK IS GOING ON HERE?

Sorry about that. But I'm afraid this is about the most incisive analysis I have to offer. The Republican health care effort is a fiasco beyond even my wildest imagination.

Back in the past, about 17 percent of Americans went without health insurance. In the future, according to the CBO, about 17 percent of Americans will go without health insurance if AHCA, the Republican health care bill, passes. In between is the short, happy valley of Obamacare, when we got that number down to about 10 percent:

The CDC has precise numbers for the present if you're interested. The Obamacare smile in the chart above is just approximate. Bottom line: if AHCA passes, not only will all the good work of Obamacare be wiped out, but uninsurance rates will actually be higher than they used to be when we had no legislation at all. I'm not quite sure how Republicans managed to pull that off, but it's an impressive feat of callousness and greed.

Are you interested in additional detail about exactly which groups will be less insured under AHCA? The answer is: all of them. Here's the absolutely appalling CBO estimate:

Poor people will have less insurance. Working-class people will have less insurance. Middle-class people will have less insurance. The young will have less insurance. The middle-aged will have less insurance. The old will have less insurance. Everybody will have less insurance. Except for the rich, of course, who will also get an $882 billion tax cut.1

This is what Paul Ryan calls "encouraging." I'm not sure how he looks at himself in the mirror every morning.

1In fairness, they have to share this tax cut with big corporations.

What do people think about the new CBO report on RepubliCare? I don't mean us bleeding heart liberals. Naturally we think it's great since it confirms that the Republican bill will decimate health care in America. But what do conservatives think?

HHS Secretary Tom Price says the CBO report is ridiculous. It "defies logic," he says:

But over on Capitol Hill, Paul Ryan says he finds the CBO's report "encouraging." It exceeded his expectations and "gives us even more room to work on good, fine-tuning finishing touches." Hoo boy. Even Fox News isn't buying this:

This is some serious happy talk. Ryan must be taking lessons from Trump. In a statement, Ryan says the report confirms that the Republican bill will "lower premiums and improve access to quality, affordable care"—which is, um, a pretty creative reading of the report. More to the point, Ryan is thrilled that the CBO confirms that the bill will provide "massive tax relief." This is true—though the tax relief is all for the rich—and it's telling that Ryan doesn't need to provide any spin on this point.

But what about all those people who will lose coverage? Ryan says, "I recognize and appreciate concerns about making sure people have access to coverage." He doesn't say he plans to do anything about this, but at least he appreciates the concerns. You know who else appreciates those concerns? Breitbart News:

The Drudge Report is pretty much ignoring the whole thing for the moment, as if they're waiting for some kind of conservative consensus to form before they wade in. National Review is pretty silent too, though Dan McLaughlin writes that "The projections of who will and won’t be insured don’t actually mean anything." The Weekly Standard's Chris Deaton has a carefully neutral post up that says millions of Americans "would opt out of purchasing coverage once the federal government stops penalizing them for doing so." That's not quite what CBO says, though I admit you have to read the report carefully to recognize this.1

Basically, no one outside of Congress or the White House really wants to defend the Republican bill. There are a few half-hearted gibes at the CBO, but nothing more. I'll be curious to see if tribal defenses kick in more strongly by tomorrow, once everyone has had a chance to suffer through all the liberal jeers and taunts.

1CBO says that subsidies after 2020 would be "significantly smaller" than they are now and that "some people would forgo insurance in response to higher premiums." However, they are oddly cagey about exactly how big an effect this would have compared to the elimination of the individual and corporate mandates. I'm not sure what the reason for this is.

While I was out to lunch, I was feeling bummed that I wouldn't immediately see the CBO score of the Republican health care bill. As Hyman Roth said, "This is the business we've chosen." Still, that's kind of pathetic, isn't it?

But I've seen it now (click here), and the headline news is CBO's projection of how many more people will become uninsured compared to Obamacare: 14 million in 2018, 21 million in 2020, and 24 million in 2026. But here's the thing. The last time I saw a CBO estimate, it projected that Obamacare would reduce the ranks of the uninsured by 27 million people in 2025, and today's report projects 28 million in 2026. So here's what the Republican plan looks like:

You read that right: CBO projects a decline of 24 million from a baseline of 28 million. Of the 28 million people currently insured because of Obamacare, only 4 million will be left by 2026.

With a couple of corrections because I mistakenly used an old CBO report, this matches almost perfectly my estimate from last week of the impact of RepubliCare. Not bad! Unfortunately, the price of my being right is that 24 million people will be uninsured yet again if Republicans manage to pass their monstrosity of a bill. Here are CBO's other three main findings:

  • The Republican bill would reduce the deficit by $337 billion over ten years, mainly by kicking lots of people off Medicaid
  • Premiums would go up until 2020, and then decrease. By 2026 they'd be about 10 percent lower than now.
  • The individual market would remain stable.

I'm a little surprised by the last bullet. According to the report, "key factors bringing about market stability include subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures, and grants to states from the Patient and State Stability Fund which would reduce the costs to insurers of people with high health care expenditures."

Unless I'm missing something, CBO is projecting "sufficient demand" at the same time they're saying that demand will crater. As for the stability fund, that comes to $10 billion per year, maybe half of which is actually for high-risk patients. That's practically a rounding error in the health care market. Something doesn't smell right here.

That said, the big news is the projection of 24 million people losing health coverage by 2026. I wondered last week if CBO would have the guts to make a projection like this, and it turns out they did. Republicans may try to keep up the pretense that their bill would continue to insure practically everyone, but the truth is just the opposite: almost no one would be covered. And that's a feature, not a bug.

UPDATE: I've changed the headline and the text from 3 million to 4 million. The CBO report I linked above projected that Obamacare would be responsible for a net increase of 27 million insured people by 2025, so I initially used that number for 2026 as well. That left 3 million still insured after a decline of 24 million. But today's CBO score says the 2026 number is 28 million under Obamacare. So 4 million would be left under the Republican bill.

I just want to say that I'm very excited by the CBO's score of the Republican health care bill. I'll explain when I get home from lunch. In the meantime, the nutshell version is pretty simple: this bill is really, really bad.

Lunchtime Photo

It's lunchtime here in California, anyway. Wile you're waiting for me to return, here's a duck:

The actual news today, such as it is, concerns the federal deficit. A few weeks ago President Trump tweeted this:

The media has not reported that the National Debt in my first month went down by $12 billion vs a $200 billion increase in Obama first mo.

ZOMG! Trump is a fiscal genius! But today the Treasury released its deficit report for February:

Sad news. January's modest surplus has been wiped out. The deficit in February was $192 billion. Just like last year. I don't suppose Trump will be tweeting about that, will he? But he still could: His February deficit is $0.74 billion less than Obama's in his first February. Is that worth a tweet?

But who cares about all this? It's just money. The real motivation for this post is to mock the Bureau of the Fiscal Service for the op-art inspired bit of visual ugliness they use to report the deficit over time. Seriously, guys? What possible piece of software could they be using to produce this? Every time I look at it the world starts spinning.

Here's a snippet from "Bernie Sanders in Trump Country," airing tonight on the Chris Hayes show:

Bernie may not believe that, but an awful lot of people probably do. This is, obviously, one of the big problems with American politics right now: both sides over-respond to extreme caricatures of the other side. So at the risk of insulting you all with a really simplistic diagram, here's the real world:

In every country, probably since the beginning of time, populations have lived on a continuum like this. Some people enjoy cultural change and look forward to it. Some are apprehensive of cultural change and resist it. At one extreme end you have stone racists and xenophobes, and at the other you have the Occupy Wall Street crowd.

But they're actually a pretty small part of the population. Standard issue Republicans and Democrats are closer to the middle, and it's just human nature that there's a limit to how much change they can accept. If you push past that limit you're going to run into political blowback.

I'd add that I suspect some of us are less open to change than we think. For example, I'd probably put myself at about an 8 on this scale intellectually. But emotionally I'm more like a 5 or 6. I'm a creature of habit, and not especially thrilled about exploring new and different places, but I'm not especially afraid of cultural change either.

In any case, my fairly obvious point here is twofold. First, both sides should try to respond to the standard issue folks on the other side, rather than pretending that they're all represented by the loudest, most extreme voices. It's easy to mount arguments against the extremists, but those arguments never actually persuade anyone. Second, we liberals should keep pushing for more tolerance of cultural change, but we should also recognize that lots of perfectly nice, perfectly ordinary people get nervous about it a lot faster than we do. That doesn't make them bad people, it just means they're a few notches away from us on the bell curve.