A plurality of voters still have no opinion about Republican Congressman Paul Ryan’s long-term budget-cutting plan, but opposition has increased over the past several weeks. By a near two-to-one margin, they don’t like his proposal for tackling spiraling Medicare costs.

The Ryan budget would reshape Americans' access to health insurance mainly through two provisions, both of which pressure people to purchase private health insurance to an extent and through mechanisms that are materially indistinguishable from the supposedly toxic Obamacare mandate. One of these Ryan budget proposals-- as yet little noticed by pundits or politicians-- is almost an exact copy of its equivalent in the Affordable Care Act. It would repeal the current exclusion from employees' income of employer contributions to their health insurance premiums, thus terminating the subsidized employer-sponsored group health regime that covers nearly 60 percent of all Americans. In its place, the Republican plan would substitute a refundable tax credit, to be provided to individuals who purchase health insurance (or to employers who purchase health insurance for their employees). When this new arrangement takes effect in 2022, the tax credit would be set at $2,300 per adult and $1,700 per child, not to exceed $5,700 per family.



Like this Ryancare tax incentive, the "individual mandate" section of the ACA, which the White House calls the "individual responsibility" provision, constitutes a pay-or-play option. Beginning Jan. 1, 2014, when the ACA provision takes effect, individuals who do not qualify for exemption on hardship or other specified grounds, must either carry health insurance or pay a tax penalty as part of their annual income tax filing. The ACA caps individuals' penalty liability at 2.5 percent of household income above the filing threshold, or a flat dollar amount ranging from $695 to $2,085, depending on family size.



Under both provisions, the result is the same: People who choose to carry health insurance have a lower tax bill than they would if they chose not to. In terms of their respective potential impact on individuals' bank accounts and tax liability, the manner in which they affect individuals' financial incentives, and hence the constraining effect on individuals' financial choices to either buy or forgo health insurance, the two "mandate" provisions are identical. (Indeed, in most cases, the financial difference for the individual taxpayer made by the Republican tax credit would be greater-- i.e., more "coercive"-- than the ACA tax penalty.)



In addition to cloning the ACA's framework for coverage of adults under 65, the Ryan budget would also apply a similar approach to Americans currently covered by Medicare. Beginning in 2021, former Medicare-eligibles would receive a voucher they can apply to the purchase of private insurance. According to the Congressional Budget Office, the vouchers would be worth approximately $6,000 for recipients age 65, and would be greater for older recipients, averaging $11,000 across the entire Medicare population. Of course, Americans would be required to continue to pay their annual Medicare tax throughout their working lives. Hence, the Republicans' proposal to replace Medicare with partially subsidized private insurance also operates to "compel" people to pay for private health insurance policies. Moreover, this mandate is not even a pay-or-play option; Medicare taxes are mandatory, whether workers want to buy eligibility for old-age vouchers or not.

While most Americans are still savoring the elimination of Osama bin-Laden, the Republican Party had something else they were hell-bent on eliminating this week: health care. Even their own right-wing polling firm , that normally tells them whatever they want to hear, had bad news about Paul Ryan's ultra-reactionary budget from hell, what he calls his "cause."So the House Republicans came back from their Easter holiday and immediately started debating pointless legislation that will go nowhere to keep people from getting the benefits of the Patient Protection and Affordable Care Act. Even in the preliminary votes on Tuesday morning, it was clear how it was going to go. All 233 Republicans (+ the 4 sleaziest and most corrupt Blue Dogs-- Altmire, Shuler, Boren and McIntyre) voted for repeal; all the rest of the Democrats voted against it.Yesterday, as the GOP was voting to take away health care rights from children and the elderly, Simon Lazarus was over at Slate explaining how Ryan's heartless budget does exactly what it accuses Obamacare of doing, compelling people to buy insurance (the individual mandate, the worst Republican plan the Democrats ever adopted).Most observers are giving Scott Walker the "credit" for the startling loss last night of the suburban La Crosse district that had been vacated when Walker picked longtime Republican Assemblyman Mike Huebsch to work as his right hand man. Democrat Steve Doyle beat Republican John Lautz 54-46%, though Republicans massively outspent the Democrats in the district they've held for 16 years and pulled out all the stops in terms of their smear machine. But not everyone agrees that it was all Walker's doing. One state legislator told us last night that "People here in Wisconsin are very worked up over Paul Ryan's budget. The bloom is off that rose and he's going to take down a good chunk of the Republican Party with him; you watch. This is especially bad news for state Senator Kapanke because he's up for recall in a district with a great deal of overlap. In fact this is thepart of the district Kapanke needs to win. So, sure, the over reach by Walker and the legislature has the voters very worked up. But so does Ryan's plan to take away Medicare. People see right through that now and no one is thinking what a nice, clean cut and well-spoken young man he is anymore. Rob Zerban is in a very good position to win a seat in Congress."Zerban himself seemed buoyed by the results in La Crosse. When we contacted him this morning he also saw the Ryan effect setting in on Wisconsin Republicans: "We are seeing an incredible amount of opposition to the Ryan budget plan and Gov. Walker's unprecedented power grab. Representative-elect Steve Doyle's election last night confirms that. People all across Wisconsin are seeing the true colors of the GOP, and rejecting their mantra of reducing taxes for the wealthiest and balancing the budget on the backs of the hard working families of Wisconsin."Meanwhile, back in Washington, the first of the two bills was voted on yesterday, H.R. 1213, which is supposed to repeal mandatory funding provided to states in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges. The Democrats' motion to recommit lost 190-233 , one Republican (Walter Jones of North Carolina) crossing the aisle to vote for healthcare and one Democrat (Dan Boren) crossing the aisle to vote against it. And what did Boren and all the Republicans but Jones vote against? "Motion to Recommit protects Americans with pre-existing conditions by requiring health insurance companies to disclose discrimination and unfair price hikes against those with pre-existing conditions like cancer and banning insurers from health exchanges if they refuse to cover Americans with pre-existing conditions or charge those patients more for their coverage. Republicans should stop their assault on patients’ rights and join Democrats in holding insurance companies accountable and ensuring every American who needs a doctor can see a doctor."The final vote on repeal itself passed 238-183 with 4 of the regular shady Blue Dogs-- Altmire, Boren McIntyre, and Holden (plus, for whatever deranged reason, Luis Gutierrez)-- crossing the aisle to vote with Boehner and Cantor.The second bill, H.R. 1214 is meant to repeal mandatory funding for school-based health center construction and the vote will come later today.So when it came to repealing mandatory funding for school-based health center construction (H.R. 1214), results were pretty predictable. It passed 235-191 , Altmire, Boren, McIntyre, joining forces with the Republicans, as usual, while 4 Republicans-- Mike Kelly (R-PA), Joe Heck (R-NV), Allen West (R-FL) and Steve LaTourette (R-OH) were more attuned to the discomfort even Republican voters are starting to feel about the madness of destroying Medicare.

Labels: health care, Paul Ryan, Rob Zerban, Wisconsin