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Paul Ryan gets grilled about latest unflattering CBO report on GOP healthcare bill

Bob Bryan
paul ryan

(Paul Ryan.Yuri Gripas/Reuters)

House Speaker Paul Ryan was bombarded with questions Thursday about the Congressional Budget Office's latest report on the GOP's healthcare bill.

Ryan pointed to the good news about the American Health Care Act in the nonpartisan agency’s report, which estimated that premiums would decrease for healthy people and that the federal budget deficit would decline if the bill were to become law.

"I'm actually comforted by the CBO report because it shows, yeah, we're going to lower premiums," Ryan said.

But the CBO's analysis also contained some alarming projections.

It estimated that 23 million more people would be without health insurance in 2026 compared with the current baseline. It also found that people with preexisting conditions could face much higher premiums because of waivers that states could use to get around of some the Affordable Care Act's regulations and that some of the changes that helped get the bill through the House could make some individual insurance markets "unstable."

The CBO report also said the premium declines would come in part because of people with preexisting conditions dropping out of the market, as insurance would become too expensive. That would drive down costs for healthy people but throw sicker people's insurance status into further question.

On May 2, Ryan's official website argued that an amendment introducing waivers "protects people with preexisting conditions," which the CBO said was not the case.

Ryan defended the idea, citing the fact that the new law would require states seeking a waiver to have a so-called high-risk pool in place, where sicker people would turn to purchase insurance.

"A state has to have a risk system in place" to get a waiver, "and that risk system is specifically designed to make sure that people with a catastrophic illness, who has a preexisting condition, also gets access to affordable healthcare," Ryan said. "What we have learned is if we target resources at the state level and the federal level to make sure we subsidize catastrophic illnesses, what you end up doing is you end up lowering premiums for everybody else. We think that's so much smarter."

The Kaiser Family Foundation, a nonpartisan health-policy think tank, however, has found that the high-risk pools Ryan cited that existed before the passing of the Affordable Care Act were woefully underfunded, had few people enrolled, and left out many sick Americans.

Additionally, health-policy experts have said the current version of the AHCA does not have enough funding allocated to the new high-risk pools to solve the problems. The CBO echoed a similar sentiment in its report Wednesday.

Ryan argued that the CBO score did not take into account the state-level funding for the high-risk pools, saying "the states will do some of the lifting."

But projections from GOP Sen. Bill Cassidy also showed that many states would have to shoulder a much larger burden of Medicaid costs because of the AHCA's changes to funding for that program.

The AHCA is now in the hands of the Senate, which has already said it will write its own version of the bill separate from the House plan.

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