Paul Ryan has long liked to think of himself as a policy wonk.

Few things appear to excite the House Speaker more than rolling up his sleeves, switching on his PowerPoint, and explaining some dry, complicated piece of proposed legislation.

Yet this week, Mr Ryan found himself the subject of no small mockery and derision for his presentation on the Republicans’ plan to repeal and replace the Affordable Care Act, commonly known as Obamacare. Some commentators even questioned whether Mr Ryan understood the basic concept of insurance.

Speaking on Capitol Hill, in an address that was televised live, Mr Ryan spent 20 minutes claiming Obamacare was in a “death spiral”, with soaring premium payments and fewer choices for consumers.

“This is the closest we will ever get to repealing and replacing Obamacare. The time is here; the time is now. This is the moment,” said Mr Ryan. “It really comes down to a binary choice.” 

Mr Ryan then went on to outline the differences between Obamacare and the the American Health Care Act, the Republican alternative. That plan has already been denounced by medical groups, organisations representing the elderly, and from some outspoken Republican politicians

Health Secretary points to smaller stack of paper to prove new healthcare bill is better than Obamacare

The American Medical Association, which was founded in 1847 and is the US’s largest group representing doctors, said in a letter to Congress that the new proposed bill being pushed by Donald Trump and the Republicans could hurt certain groups.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” it said.

Mr Ryan started his discussion by saying he wanted to explain what his new bill represented.

“I want to walk you through exactly what this health care law is, and what we’re replacing, and how important it is to repeal and replace Obamacare, not just because the law is collapsing, but because the law is going to get even worse if we do nothing,” he said.

Mr Ryan was quickly mocked on Twitter, whose presentation came a day after an an interview with Tucker Carlson on Fox News, who said the American Health Care Act “looked like chaos”.

Among those to criticise Mr Ryan was Jedd Legum of the liberal Think Progress website.

“Ryan seems confused at the basic concept of insurance. He criticises Obamacare because he makes healthy people pay for sick people,” he wrote.

“Is he also upset that car insurance makes people who don't get into wrecks help pay for people who do get into wrecks? This is literally the definition of insurance.”

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