There are two questions Republicans in Congress don't want you to ask about Obamacare. First, if Obamcare is so bad, why does the Republican budget rely on major parts of Obamacare in order to balance? Second, if Obamacare will ruin us, why is the Republican plan for Medicare based on virtually the same model as Obamacare?
Let's look at each of these in turn. The Republican budget, authored by Representative Paul Ryan, incorporates all the Medicare savings from the Affordable Care Act (also referred to as Obamacare). Yes, these are the same savings that Governor Romney, and then-Vice-Presidential candidate Paul Ryan, claimed would ruin the Medicare system. But as soon as the campaign was over, Representative Ryan included all of those savings in the Republican budget. These savings come to more than $700 billion over 10 years, including savings of about $145 billion in the tenth year of their budget - the year they claim that their budget comes into balance.
The Republican budget, which virtually every Republican in Congress voted for, also assumes the exact same amount of new tax revenue that would be generated from the Affordable Care Act - $1 trillion over 10 years, including about $175 billion in the tenth year. Now, Republicans say that they will raise this amount of tax revenue from other sources, but they can't tell you where they plan to get one dime of it. Even the Heritage Foundation noted that the Republican budget relied on the taxes in the Affordable Care Act, stating that the Republican budget "keeps the tax increases associated with Obamacare."
Simple math shows that without these Affordable Care Act provisions and associated effects on federal net interest payments, the Republican budget falls about $400 billion short of balance in the tenth year. Therefore, it is simply a hoax for Republicans to claim that they have a balanced budget and, at the same time, say they plan to eliminate Obamacare.
Here's the other secret Republicans in Congress don't want their constituents to know. While they oppose the Affordable Care Act, which will offer affordable coverage to millions of Americans who currently have no other option, they are pushing to move millions of future seniors, who would otherwise have the guaranteed coverage of Medicare, into a system very much like Obamacare. The core of the Affordable Care Act is a system of regulated, market-based exchanges that allows individuals without offers of affordable coverage to purchase quality health insurance. While Republicans in Congress are threatening to shut down the government to block these exchanges from opening on October 1st, the Republican Budget plan transforms Medicare into a similar system.
The Affordable Care Act is based on the idea that everyone has a responsibility to have a health insurance policy to cover their health care risks. Our seniors have Medicare, and most other people get health insurance through their employer. But, for those without affordable offers of coverage from other sources, the Affordable Care Act establishes a sliding scale of income-based tax credits to help these individuals purchase policies in the health insurance exchanges. The Republican Medicare "premium support" plan, authored by Representative Ryan, is based on virtually the same model. Instead of a tax credit, seniors would be given a fixed amount of "premium support" to purchase insurance policies offered in a government-regulated, market-based "Medicare Exchange." Premium support payments in this plan would not be guaranteed to keep pace with rising health costs, shifting more financial risk onto seniors.
The result is a puzzling contradiction. On the one hand, Republicans want to radically transform and weaken the successful Medicare program that already provides affordable, quality care for millions of seniors into an Obamacare-style system. On the other hand, they want to deny millions of other Americans, who have no access to affordable coverage, the ability to enter the type of system that they are proposing for Medicare.
The puzzle is solved if we keep in mind the unifying theme behind these Republican plans - minimizing the government role in the financing of health care. That explains why Republicans today seek to move Medicare away from a single-payer model toward the Affordable Care Act model of regulated private market exchanges, while simultaneously working to deny the millions of uninsured Americans access to affordable coverage through the Affordable Care Act.
This puzzle also adds a rich twist to the infamous Tea Party confusion embodied by the placards that read "keep the government out of my Medicare" while dubbing Obamacare "the government takeover of health care" - a falsehood that earned the Politifact "Lie of the Year" award in 2010. The irony, of course, is that the federal government plays a far larger role in Medicare, a single-payer system, than it does in the Affordable Care Act. Yet imagine the horror of Tea Party constituents when they realize that Congressional Republicans are trying to comply with their demands to get the government out of Medicare by turning it into the dreaded Obamacare. After all, while the Obamacare system of exchanges and tax credits is a big step up for individuals without insurance, the parallel Republican plan of exchanges and premium support would be a big step down for seniors who have guaranteed Medicare coverage.
It is time to blow the whistle on the anti-Obamacare hypocrisy. The reality is that the Republican Budget would not come into balance without the Affordable Care Act, and Republicans think that the Affordable Care Act is a good model - not for the millions of uninsured, hard-working American families, but for the millions of seniors who would otherwise enjoy guaranteed coverage through Medicare.
Chris Van Hollen is a Democratic Member of Congress from Maryland and Ranking Member of the House Budget Committee