The Slatest

Paul Ryan, About Seven Years Too Late, Explains Why Full Repeal Would Be a Disaster

Speaker of the House Paul Ryan explains the Republican plan to replace the Affordable Care Act during his weekly press conference on Thursday.

Win McNamee/Getty Images

Broadcasting live from rock bottom, House Speaker Paul Ryan on Thursday used a PowerPoint presentation to explain to reporters and the American people why they should like his health care bill that no one likes. You knew he was going to delve into the weeds because, like any cool hands-on wonk, he took off his suit coat and rolled up his sleeves.

(At this point, if you would prefer to stop reading this post and instead just make funny Photoshops of the television screen on which Ryan was displaying his PowerPoint—a decision I fully understand—here is a template provided by the Washington Post’s Philip Bump.)


Ryan explained that there are three parts to the full “repeal and replace” effort, something that people may not understand because he hasn’t explained it very well. It is true that the plan ideally has three prongs. As Slate has written, the idea is for Congress to repeal and replace as many budget-pertaining items as allowed through reconciliation, while HHS Secretary Tom Price uses the discretion available to him—the powers he feigned ignorance of during his confirmation hearings—to weaken other Obamacare regulations. The third phase, as Ryan explained, is to pass a flurry of other regulatory bills that don’t directly pertain to the budget. This third phase is intended to come later in the year. Since all of these bills would require 60 votes in the Senate, the third phase may be brief.

Ryan went through many of the bill’s major components. He explained how expanded health savings accounts—having some “skin in the game”—will allow people to save for Lasik eye surgery, like he did some years ago. (He did not explain how health savings accounts would allow, say, people with no savings to pay for chemotherapy.) He pointed out a number of states where premiums and deductibles for Obamacare exchange plans are soaring while options are dwindling—a real problem!—without noting a single area of Obamacare success that might give pause to those demanding to repeal it fully.

Those who want to repeal it fully are the ones with whom Ryan is having trouble. The most striking moment of the presentation came during the question and answer session, when he appeared to give his most direct response yet as to why he can’t do what conservative agitators in his party want him to do: a “clean repeal” of the law.

“What [the insurance industry] also tells us,” Ryan said, “is that if you only repeal the law—gut and repeal the law, as some folks are suggesting—then you have triple-digit premium increases, and you’ll collapse the individual market.”

Yes! You would! Jesus! This is a very important point—so important that perhaps Ryan and all other Republicans should have worked this into their rhetoric for the past seven years.

Ryan and all Republican leaders haven’t just promised full repeal for seven years. They’ve passed legislation to do so in the House dozens of times in the past six years. In 2015, they sent to President Obama’s desk a near-total repeal bill that they knew he would veto, a bill they now won’t dare pass knowing that it could be signed. If leaders are having trouble getting their rank and file to believe him now as he sells this plan, there’s good reason for that, and it’s a problem a PowerPoint won’t resolve.