Paul Ryan admits fewer people will probably be covered under Trumpcare

House Speaker Paul Ryan acknowledged Friday morning that the proposed “Trumpcare” healthcare bill will likely cover fewer people than the current system under Obamacare.

“You’re never going to win a coverage beauty contest when it’s free market versus government mandates,” he told conservative radio host Hugh Hewitt.

Ryan said the Congressional Budget Office (CBO), which is releasing its report on the proposed healthcare bill on Monday, would likely conclude that fewer people would have health insurance under the Republicans’ new plan.

“If the government says thou shall buy our health insurance, the government estimates are going to say people will comply and it will happen,” Ryan said in reference to Obamacare’s individual mandate, which the new bill would scrap. “And when you replace that with ‘We’re going to have a free market, and you buy what you want to buy,’ they’re going to say not nearly as many people are going to do that.”

The left-leaning Brookings Institution agreed with that assessment this week, projecting the CBO will likely estimate about 15 million people will lose coverage under the proposed bill.

Ryan’s comments mirror those of conservative members of Congress and advocacy groups who have long argued that the healthcare system will be improved with less government interference. “We’re not going to get into a bidding war with the left about how much we can mandate or put entitlements out there for people,” Ryan said. Several members of the ideological Freedom Caucus have said they do not want to create another entitlement program and will not vote for a bill that some have called “Obamacare Lite.”

But Ryan’s small-government defense contradicts President Donald Trump’s repeated promises that his plan would provide “insurance for everybody.”

Secretary for Health and Human Services Tom Price reinforced Trump’s promise just this morning in an interview with MSNBC, saying, “We don’t believe that individuals will lose coverage at all so long as they are able to select the kind of plan that they want for themselves and for their family.”

The apparent contradictions between the GOP leaders speaks to a larger ideological debate within the GOP. Trump’s winning platform broke with many of the free-market, free-trade orthodoxies espoused by GOP stalwarts like Ryan and Senator Ted Cruz, leaning in favor of what his adviser Steve Bannon has termed “economic nationalism.”

Though Trump promised to do away with Obamacare, he also accepted the premise that it was the government’s job to help ensure that people had healthcare. He even praised the single-payer health system in Canada, though he noted it would be difficult to implement now.

When the CBO releases its report next week, the ideological friction will likely heat up again. Some conservatives believe the plan should provide fewer people with coverage and scale back what they consider to be a big government entitlement program. A CBO score showing drops in coverage could burnish their conservative credentials and prove that they’re getting government out of the healthcare business.

Other Republicans, including the White House, have already begun to undermine the CBO’s credibility, anxious of being perceived as taking away people’s health care. “If you’re looking to the CBO for accuracy, you’re looking in the wrong place,” White House Press Secretary Sean Spicer preemptively warned on Wednesday.

It may be difficult for the Trump administration to outright dismiss the CBO’s report, however, since its director Keith Hall was handpicked by the Republican Congress just two years ago because of his conservative, market-oriented views.

He also publicly opposed Obamacare.
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