House Speaker Paul Ryan of Wis. speaks during a news conference at the Republican National Committee Headquarters on Capitol Hill. (AP Photo/J. Scott Applewhite)

Republicans intent on scrapping Barack Obama’s Affordable Care Act have a budget problem.

As it turns out, repealing and replacing the law they hate so much won’t save nearly as much money as getting rid of it entirely, the goal they’ve been campaigning on for seven years. That means trouble for the federal deficit and for Congress’ fiscal conservatives who repeatedly warn about leaving their children and grandchildren worse off financially.

President Donald Trump and other GOP leaders know they can’t just get rid of the law; instead they’ve vowed to “repeal and replace” it. So they’ve come up with a bill that would fix Obama’s “disaster” and insist it would give Americans more choices on health coverage.

But it only reduces the deficit by $337 billion over a decade and doesn’t move the federal budget much closer to being balanced, if at all. That’s one big reason many budget-conscious Republicans have joined Democrats in opposing the repeal-and-replace version pushed by the White House and House Speaker Paul Ryan, R-Wis.

In proposing his 2018 budget on Thursday, Trump called for spending billions more on defense while slashing domestic programs. He vowed during the campaign to leave the costly mandatory programs such as Medicare and Social Security untouched, and he won’t raise taxes. That budget plan guarantees large deficits.

“Our military is more important to me than a balanced budget,” Trump said in a Fox News interview in January.

The initial Republican plan to completely scuttle the 2010 health care law promised a cut of more than $2 trillion from the deficit over 10 years.

The GOP health care bill cuts the deficit by much less.

“Now that (health care repeal) is actually going to happen, they’ve changed their priorities greatly so that they’re not actually trying to generate any significant savings,” said Maya MacGuineas, president of Committee for a Responsible Federal Budget, a Washington-based advocacy group for budget discipline. “And there’s no sign what they can fill it in with.”

A senior member of the House Budget Committee, Rep. Tom Cole, R-Okla., says: “Oh yeah, there’s no question. It’s much tougher, much tougher” to balance the budget after repealing and replacing the health care law.

What would be left behind, according to the Congressional Budget Office, is $9 trillion in projected deficits over the coming decade and fewer ways for Trump and Republicans controlling Congress to cut.

The worsening deficit creates a huge problem for other critical pieces of Trump’s agenda, including tax reform, a big infusion of infrastructure spending or helping people with the costs of child care.

First, swelling deficits mean less money for such legislation.

The deepening debt hole also means problems when Republicans try to pass a budget outline this spring, since some tea party Republicans and deficit hard-liners will insist on promising to balance the budget even though the math no longer works. More realistic lawmakers will resist that.

Under the arcane congressional budget process, the yearly budget blueprint doesn’t by itself make any changes to government programs, but it makes it easier to enact follow-up legislation like tax reform, which is the top GOP priority after dealing with health care.

But if they can’t pass a budget, Republicans can’t pass tax reform — at least without help from Senate Democrats — because of Senate rules.

The fiscal picture, meanwhile, has another complication. If Republicans can successfully pass their health care repeal and replacement they will have used up their opportunity to cut Medicaid to generate savings toward a balanced budget. The health measure promises an enormous $880 billion cut from Medicaid over 10 years and it’s not credible to say Republicans could claim more in subsequent legislation.

“They’ve taken (Medicaid) off the table,” said Douglas Holtz-Eakin, a conservative economist and former Congressional Budget Office director.

“The math doesn’t work,” said Sen. Chris Van Hollen, D-Md. “Just nothing that they’re doing adds up right now.”

How big is the problem? According to calculations by the Committee for a Responsible Federal Budget, if House Republicans were to simply plug their health repeal and replace bill into last year’s budget resolution, they would fall $350 billion short of balance by the end of their 10-year goal. And if further Medicaid savings are taken off the table, the gap is more like $500 billion.

“It’s going to be extremely difficult,” admitted budget panel member Cole.
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7 COMMENTS

  1. It’s all nonsense anyway: If you cut off Medicaid then those poor people go get very expensive ER treatment and lousy followup care. Hospitals charge their care to other insured patients and get government subsidies, so we all pay for it. But we pay a lot more because ERs are much more expensive than doctor’s office visits. They are just shuffling around the deck chairs on the Titanic. Single payer works fine for the military, their dependents, their retirees, and the VA. Why not for everybody? Its got to be cheaper than what we have now.

    BTW: Why not just call Republican “tax reform” the “give rich people more money” plan? That would be a lot more honest.

  2. You have to admit that with all of the shortcomings of the ACA, the way Obama put it together was genius. In that it’s not susceptible to congressional funding. But it’s the plan put forward by the Heritage Foundation and by Mitt Romney when he was governor of Massachusetts. Look on YouTube and you’ll see Newt Gingrich singing its praises in the 1970’s about the individual mandate. The hippocracy is incredible, but unfortunately, the voters have short memories.

    • Hafta admit I love the idea of a hippocracy. Rule by hippopotamus!

      It works! They’re highly dangerous (kill far more people than sharks (Hipponado, anyone?)) enormous flatulent herd animals that blunder around in the dark doing tremendous damage and hide from the light by burying themselves up to their noses in mud.

      The word you want might be ‘hypocrisy’, but I like hippocracy. It’s difficult to think of a better metaphor for today’s government of the USA.

      Thanks, J.

      • Thank you Jon. My spell check didn’t catch it. In what you’ve described, both would be applicable, but the way you put it, I’d go with your definition.

  3. It’s not supposed to add up. That takes math.

    For all the good the NEA does, the same money also buys about fifteen feet of aircraft carrier, and one and a half F-35s. It buys less than one mile of the 405 freeway (in Los Angeles, and that wasn’t building it, that was just expanding it). Depending on estimates, it costs the same as 40 of President Trump’s trips to Florida, and anywhere between four months and two years of Melania Trump staying in New York City. Somehow I don’t see his budget cutting those…

    That’s just one part of it. Cutting spending on Planned Parenthood just increases spending (by far more) at other clinics and hospitals. Cutting spending on IRS enforcement costs the government $5 for every $1 they cut.

    But math, oh, math. Math is something only those librul elites in their ivory towers at colleges on the coasts do. Regular people don’t need math. Regular people just go with their gut (thank you, Dubya). Math? That’s just numbers. Don’t mean nothin’. Math. Hah.

    J.

    • Thank you Jon. Don’t beat around the bush. Come and point out facts. But not to worry. The Republicans don’t give a shit about the people as much as the military and their corporations. Guess what’s coming up? They’re going to have to increase the debt ceiling! I’m really looking forward as to how they’re going to justify it. Oh, that’s right. It’s to pay bills for what has already been done. I’m really looking forward to the hippocracy.

  4. Politically, it’s impossible to repeal ACA without enacting a replacement of some kind. It would be suicide for Republicans, as their constituents have come to expect and need access to affordable health insurance and health care. Unfortunately, for Republicans, they are philosophically opposed to any kind of government backed health care plan, and the results they have arrived at shows that. They don’t want to do it. They are being forced into doing it, and are doing a poor job as a result.

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