Two days after President-elect Donald Trump promised health insurance “for everybody,” the Congressional Budget Office concluded Tuesday that a Republican plan to repeal parts of Obamacare would strip 18 million Americans of insurance in the very first year.
Trump is saying one thing, while Republicans in Congress are saying entirely something else, and the winner could be the Affordable Care Act. Trump has laid down a standard for replacing the ACA — even broader coverage at lower cost — that no Republican plan can meet, phased in or not. Nor should anybody believe Trump that he’s got a secret plan that would achieve both goals. Trump is a real estate developer, not a miracle worker, and nobody has ever made the numbers add up.
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A stand-off with the new administration could compel Congress to slow efforts to repeal the Affordable Care Act, much to the relief of 20 million of Americans who perhaps fear losing their coverage. But the best outcome would be if Trump and the Republican Party finally came to their senses, after eight years of loathing anything with President Obama’s name attached to it, and accepted that the smart move would be to improve Obamacare, not replace it.
Any ACA replacement that meets Trump’s standard of “insurance for everybody” that is “much less expensive and much better” inevitably will require even greater government regulation of the marketplace. And if, on the other hand, the GOP replaces the ACA with something less and millions of Americans again can’t get good and affordable insurance, the party will suffer the political consequences.
There is an element of farce to Trump promising the world even as his own Republican Party plots to deliver less. On a series of key issues, from creating jobs to defeating terrorism, Trump is not so much a Republican or a Democrat as he is a party planner, promising “beautiful” and “amazing” results without offering a workable way. The American people are his studio audience and he promises a gift under every seat.
Trump can’t even count on support from some of his own Cabinet picks. His choice for defense secretary, retired Gen. James Mattis, advocates a much harder line on Russia. His nominee to run the CIA, Rep. Mike Pompeo, says our nation must honor the nuclear deal with Iran. His choice for secretary of health, Rep. Tom Price, is the author of an ACA replacement plan that would lower quality standards and not set universal coverage as a goal.
If the findings released Tuesday by the Congressional Budget Office don’t give Republicans in Congress reason to pause, we don’t know what will. The CBO not only concluded that 18 million Americans would lose their insurance in the first year if Obamacare were partially repealed, such as eliminating tax penalties for people who go without insurance; it also would increase the number of uninsured Americans by 32 million in 10 years. In that decade, insurance premiums would double.
Republicans say they are most offended, philosophically, by the “individual mandate” provision of the Affordable Care Act, which requires people to have health insurance coverage or pay a penalty. But any ACA replacement would have to include equally strong incentives for people to buy insurance so that it is affordable for “everyone,” as Trump requires. If younger and healthier people can easily opt out, the cost of insurance for everybody else — the older and sicker — becomes unaffordably high.
“We’re going to have insurance for everybody,” Trump told The Washington Post in a weekend interview. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen.”
But Trump did not reveal how he would pull that off, saying he’s waiting for Price to be confirmed as secretary of health. Such is Trump’s way: Promise and delay.
Nobody in the studio audience should expect to find a gift from Trump under their chair.
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