Response to Ryan’s Interview on Upfront with Mike Gousha
Speaker Paul Ryan appeared on Upfront with Mike Gousha this morning and discussed a variety of topics. Ryan did a good job of explaining his policy positions, but left out some key data points, facts and ideas that should be considered as well. Below provides some additional information and perspective that should be considered when reviewing Speaker Ryan’s policy positions:
The Affordable Care Act is collapsing and insurers are pulling out of the marketplaces.
Speaker Ryan likes to consistently use the fact that insurance companies have pulled out of certain markets as his primary evidence that the Affordable Care Act (ACA) is a failing law and collapsing. Unfortunately, he’s only providing part of the story. According to the Kaiser Foundation, 98% of the counties with one health insurer are in states with a Republican controlled legislature. These Republican lawmakers have declined the law’s Medicaid expansion and have consistently denounced the law. Their actions (or more accurate inactions) have helped to create the instability of the health insurance markets in these counties. Also individual health insurance only accounts for 7% of Americans. 36% of Americans receive health insurance from the government and 49% get health insurance from their employer. About 8–9% of Americans do not have any health insurance.
According to the Kaiser Foundation, the individual health insurance markets are stabilizing, earned largest amount of revenue per person by quarter and insurers are beginning to become profitable across the country. All Americans do receive the additional protections that are afforded in the ACA such as no lifetime coverage limits, not being denied coverage due to a pre-existing condition, extending coverage from parents’ health insurance coverage to young adults up to 26 and covering preventative care at no cost — among other things. Repealing the ACA, would remove these protections, cut Medicaid funding dramatically and result in 22–35 million more Americans without health insurance depending on a full repeal or repeal and replace.
Sources: http://www.kff.org/health-reform/issue-brief/individual-insurance-market-performance-in-early-2017/
http://www.charlotteobserver.com/opinion/editorials/article161423163.html
Increasing competition with patient-centered healthcare instead of single-payer.
All too often in the healthcare debate — healthcare services and insurance are co-mingled making it difficult to differentiate one from the other. We absolutely need healthcare services competing to drive down costs, innovate and improve care for all of us. We also need to ensure that all Americans have access to care and can afford to pay for it. In today’s model — half of Americans have their health insurance coverage chosen by their employer (so very little choice). The good news is that you can have patient-centered healthcare and introduce a Medicare-for-All option.
Medicare for All would allow any American regardless of age to purchase a Medicare health insurance plan. Americans would have the choice between their employers’ health insurance, individual health insurance in marketplaces or choosing Medicare for All. They would be able to select the plan that fits their needs. Low-income and needy Americans would still be able to get Medicaid-like insurance as they do today, but it would be rolled underneath the Medicare-for-All program.
From 1984 to 2014, Medicare achieved annual average cost increase of 5.7% vs 7% for private insurance. Medicare-for-All would have a distinct competitive advantage in the health insurance industry. There is no denying that, but that advantage would be an advantage for the American people. Private insurance companies would have to compete and innovate much harder to produce better value, lower costs and deliver an option more compelling than Medicare. Conversely, Medicare will need to constantly innovate and improve the insurance that it delivers as well. Ultimately, the American people win and have better health care options as a result.
High risk individuals in the general insurance pool are a primary driver of rising premiums.
Ryan argued that it would be better to create high-risk pools that the government would subsidize, which would lower premiums for everyone else since high-risk individuals would be removed from the general risk pool.
Any American can become high-risk at any time and it’s often hard to predict. Removing high-risk individuals from the general pool creates two distinct issues. First, from an actuarial perspective, the general insurance pool is no longer factoring in the possibility of high-risk individuals and therefore will not price the risk accordingly. Meaning everyone will be paying less today, but sacrificing having enough money in the pool to cover all of the costs tomorrow because the expectation will be that anyone in the general pool that becomes high-risk will be moved out. Second, the high risk pool will charge much higher premiums because it will not have healthy, low risk insureds to help spread the cost out and these individuals will be dependent on the government’s assistance. If the government decides to stop or doesn’t keep up and increase the subsidies — these Americans risk losing health insurance due to very high premiums.
Creating a larger general insurance pool is the most effective way to manage costs and lessens the chance that someone ends up without health insurance when they get sick. A large and diverse insurance pool allows costs to spread out across the entire population, which helps balance risk, control costs and ensure everyone has good quality health insurance. Insurance in America is a commodity, which means that the best way to lower costs is to get the largest and most diverse insurance pool as possible. Medicare-for-All would provide a path for everyone to have insurance and means to pay for healthcare, which would increase demand and provide a better environment for healthcare providers to compete for our business. In the end — Americans win.
Congressional Budget Office estimate of 22 million losing health insurance coverage is inaccurate.
This is a common refrain from Paul Ryan to combat the criticism he’s received around his healthcare bill, American Health Care Act, leading to 22 million more Americans without health insurance. First, the CBO is providing an estimate based on the relevant facts and data around a bill. Second, analyzing their predictions on the Affordable Care Act and what has happened — they did a really good job. Just because Speaker Ryan doesn’t like the number and it doesn’t help promote his healthcare bill — doesn’t mean that it isn’t a good indication of what would happen. We know — with no doubt — that Ryan’s healthcare bill does mean a massive tax cut for the top 1%.
Source: http://www.factcheck.org/2017/03/cbos-obamacare-predictions-how-accurate/
America has one of the highest business tax rate around the world — inhibiting our businesses to compete globally.
America does have a high marginal tax rate and it ranks very close to the top compared to the rest of the world. That only tells part of the story, since businesses do not pay the top marginal tax rate due to many factors like tax deductions — they instead pay the effective tax rate. In terms of the effective tax rate, the U.S. is very comparable to the rest of the world.

Ryan pointed out that some businesses in Wisconsin file their taxes as individuals and have a federal effective tax rate of up to 44.6%. According to the Small Business Administration, these businesses have an estimated average effective tax rate of 19.8%. This means Wisconsin small businesses are paying around 20 cents for every dollar of profit to the federal government and not the nearly 50 cents as Ryan stated.
Ryan says U.S. businesses are struggling to compete, but have had record profits since the end of the Great Recession. Meanwhile, wages have been relatively flat since the last time the corporate tax rate was cut in the 1980’s. The current tax rate does not seem to be an issue with making profits and those record profits have not made their way to working people in the form of higher wages. Before we reward large corporations with additional tax cuts, we should be working to help hard working Americans across our nation raise their wages.
Sources: https://www.cbpp.org/research/federal-tax/actual-us-corporate-tax-rates-are-in-line-with-comparable-countries
https://www.sba.gov/sites/default/files/rs343tot.pdf
https://fred.stlouisfed.org/series/CP#0
Individual tax rates need to be lowered and simplified to help drive economic growth.
Paul Ryan is confident that Republicans will be able to pass tax reform before the end of the year. Ryan’s plan calls to flatten the personal income tax by lowering the top rate from 39.6% to 33% and decrease the number of tax brackets from 7 to 3 (35% to 33%, 28% to 25%, 15% to 12% and 10% up to 12%). In addition, he would eliminate many of today’s tax deductions and instead double the standard deduction.
Ryan’s tax plan effectively rewards those making over $400,000 a year the most. His tax cuts would save a typical household about $600 in taxes a year, while saving the top 1% of the wealthiest Americans over $200,000 a year.
A non-partisan group, The Tax Policy Center, reviewed Ryan’s tax reform plan and estimated his plan could reduce growth in Gross Domestic Product (GDP) by 0.5% after 10 years and by 2.6% after 20 years. His plan would encourage short-term spending and its related economic growth. Over the long-term, however, his plan creates less tax revenue, which would require increased government borrowing and put a drag on future economic activity. It’s estimated that Ryan’s plan would result in $2.4 trillion less in tax revenues over the first decade after passing.
We always need to be careful to not over tax. Spending without restraint, without thoughtfulness and without integrity are equally destructive. Paul Ryan’s tax reform will not help working families. Instead of cutting taxes for wealthy, we need to invest in infrastructure, education and training to help Americans become more competitive, marketable and able to adapt to the changing economic landscape. Through our investments, we can help Americans land better career opportunities, raise wages and increase opportunity for all Americans.
Source: https://taxlawjournal.columbia.edu/article/an-analysis-of-the-house-gop-tax-plan/
Public town halls would bring activists and disruption, so I find other ways to connect with my constituents.
Paul Ryan has answered the criticism that he will not hold a public town hall with the fact that as Speaker of the House — he will draw out-of-state activists, protests and unsafe situations for his constituents. He instead leverages business town halls and telephone town halls to connect with his constituents.
The problem with Ryan’s approach is that if you’re not an employee of the business, member of the organization or affiliated with the place he’s visiting — you’ll be unable to attend. If you’re not on his telephone town hall list, you’re not included in the invite. He also doesn’t openly promote how to get on the telephone town hall list. Finally, it is very difficult to ask a question and have a dialogue on a telephone town hall and it really becomes another mechanism for Ryan to deliver his talking points. All of these methods are designed to control the audience and the message that is delivered.
Today, many elected officials have abandoned the town hall due to a combination of not wanting to face unhappy constituents, relying on media to share information and a desire to stay in their D.C. bubbles. In the digital age — meeting face-to-face is more important than ever, because it’s easy to have a false sense of the community’s pulse and what truly matters to people. Another key factor is that it’s hard to gain empathy and for someone or a community if you’re not actually meeting in-person with the people that live there. Empathy for others is a emotional intelligence competency that is dramatically lacking in our government these days.
There would be many ways that Ryan could meet with his constituents in a personal, face-to-face, civil and safe manner. He just has to want to do it. He’s met with donors and supporters in the district, so we know that it’s possible for him to meet with other constituents — he just doesn’t want to do it.
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