Paul Ryan Thinks People Losing Health Insurance Is About Freedom, Not Access

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As legislators continue to debate House Republicans' plan to repeal and replace former President Barack Obama's Affordable Care Act, many are wondering just how many people stand to lose their health insurance should the American Health Care Act be passed by Congress and signed into law. Although the answer to that question varies depending on who you ask, the bill's biggest champion, Speaker of the House Paul Ryan, didn't seem overtly concerned that people might lose coverage under the GOP's bill. Rather, in an interview on CBS' Face The Nation Sunday, Ryan framed the issue of potential coverage loss as a product of consumer choice rather than an effect of reduced access.

In its analysis of the American Health Care Act's potential impact the Brookings Institute concluded that 15 million people would lose coverage over the course of 10 years. A separate analysis done by Standard & Poor estimated that 6 million to 10 million people would lose coverage by 2024. Yet Ryan, who introduced the bill nearly a week ago, said he "can't answer" how many people stand to lose their coverage should the House GOP bill be passed into law.

"It's up to people," Ryan told host John Dickerson, in comments that attempted to frame the issue as a matter of individual freedom.

"We're not going to make an American do what they don't want to do," Ryan said in regards to the bill's plan to eliminate the individual mandate set forth under the Affordable Care Act. "You get it if you want it. That's freedom. ... People are going to do what they want to do with their lives because we believe in individual freedom in this country."

However, critics of the bill have raised concerns that dismantling the strict insurance reforms outlined in the Affordable Care Act and eliminating subsidies and Medicaid expansion could lead to reduced coverage and higher insurance premiums that would effectively hinder many elderly and low-income people from being able to afford or obtain coverage.

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While Ryan acknowledged the Congressional Budget Office would likely find that "not as many people will get covered" in their assessment of the bill, he attributed the potential drop to the American Health Care Act's elimination of government mandates. "This is not the government makes you buy what we say you should buy and therefore the government thinks you're all going to buy it," Ryan said. "There's no way ... you can compete on paper with a government mandate with coverage."

The House speaker also dismissed concerns the bill would unexpectedly leave people without coverage. "There will be a smooth transition, a stable transition, so that people who are covered today don't have the rug pulled out from under them," Ryan said. "What we are trying to achieve here is bringing down the cost of care, bringing down the cost of insurance not through government mandates and monopolies but by having more choice in competition."