Avik Roy Goes To Hacktacular Lengths To Defend BCRA

Avik Roy, the conservative health care hack, has yet another amazing op-ed in the NY Times today, following on yesterday's equally striking one from Wisconsin Senator Ron Johnson. In his opinion piece, Roy goes the only place Republicans can go in defending the BCRA and that is to simply claim the CBO is wrong and then claims that the bill is actually bipartisan, drawing on Democratic health care ideas.

Roy is the guy who tweeted the other day, "I'm very open to thoughtful critiques of the Senate bill form the left. 'MILLIONS WILL DIE' is not it." That just gives you an insight into the straw-man lies that Roy likes to tell. First, no one has ever claimed millions will die, only over 200,000 over the next ten years. Roy, of course, has not refuted that. And if he wanted a thoughtful critique of the BCRA, I think the CBO just gave it to him.

In his piece, Roy points to a proposal made in 1995 by Bill Clinton to link spending per-enrollee to some economic metric. Clinton's proposal used GDP while the BCRA uses CPI. Roy notes the medical inflation is often greater than GDP growth but interestingly fails to mention that it is also greater than the CPI number that the BCRA will use. What Roy also fails to mention is that the Clinton proposal was not part of the Clinton health care plan as he would like us to believe if we did not do the research. Instead it was a proposal to head off an even worse proposal from the GOP in budget negotiations to avoid another government shutdown, long after the Clinton health care plan went down to defeat. The GOP plan to destroy Medicaid in that case was similar to the BCRA today, to simply block grant Medicaid money to the states and cut those grants by three times more than Clinton's proposal over just seven years. Clinton's proposal was made 20 years ago in a climate of GOP control of Congress that was attempting to gut Medicaid just as Republicans are doing today. To say this reflects any kind of Democratic thinking on Medicaid today is totally disingenuous. But that is what Roy is doing.

Roy follows that lie about Clinton with another whopper, writing, "The Senate bill replaces the A.C.A.’s Medicaid expansion with a robust system of tax credits for which everyone under the poverty line is eligible. Under Obamacare, you could enroll in private insurance exchanges only if your income exceeded the poverty line." Again, Roy tries to give the impression that the ACA wasn't helping those below the poverty line. But enrolling those below the poverty line in Medicaid was the whole point of the ACA's Medicaid expansion. Or at least that was the plan until Chief Justice Roberts demolished another long-standing precedent and allowed states to back out of Medicaid expansion which a number of red states did. Those states are free to join in the expansion to this day.

Roy then goes on to claim that increased tax credits for younger people will encourage them to enroll in private health insurance plans and thereby bring down the costs for everyone. The problem with this statement is it's just not true. The tax credits in the BCRA are not as robust as in the ACA, the coverage will be worse and the deductibles higher. And for older people, cost will rise significantly because the cost ratio for older enrollees is moving from 3:1 to 5:1.

Roy finally gets around to discussing some of the differences between the ACA and the BCRA, writing, "The bipartisan heritage of the bill does not eliminate areas of philosophical disagreement between conservatives and progressives. It increases the role of private insurers, and decreases the role of state-run Medicaid programs in covering the uninsured. It reduces federal spending on health care, whereas Obamacare increased it. The Senate bill repeals or rolls back all of the A.C.A.’s tax increases." Hmm, that doesn't sound very bipartisan to me but I'm not a GOP hack. I'm thinking that there's a pretty large partisan divide between increasing spending on health care and decreasing it.

Roy then goes into an extended riff on a mythical compromise bill that could have been passed in 2009 that would have combined elements of the ACA supported by Democrats with the GOP plan to gut Medicaid. I have a feeling there was a reason that compromise bill never happened. But that doesn't deter Roy who simply claims the BCRA is that compromise bill. It is a remarkable proposition to create a fictional bill that never passed that you label "bipartisan" and then claim that the bill you are offering is that very same bill. But that is how far down the rabbit hole Roy is taking us.

Roy decides to end with his biggest lie of all, saying, "It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today. The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods." The CBO is nowhere claiming that removing the individual mandate will mean 15 million people will not buy health insurance. What the CBO is claiming is that 15 million people will not be able to afford either health insurance at all or the high deductibles and co-pays and pathetic coverage of the insurance they buy actually make it economically nonsensical to waste money on premiums that get them nothing. Roy makes no effort to refute that or explain why the CBO methodology is flawed.

You'd think this op-ed couldn't get any worse but it does. The Times describes Roy as "the president of the Foundation for Research on Equal Opportunity, is the author of 'How Medicaid Fails the Poor'." But NY Magazine specifically asked Roy if he had a hand in crafting the BRCA. Roy's answer is an evasion worthy of Donald Trump, "As a matter of policy, I don’t discuss with the press my conversations with policymakers." You think that might be worth a mention to the Times' readers of Roy's claptrap.