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Donald Trump’s plan would take health insurance away from 21 million people. Sad!

Donald Trump
Donald Trump.

Donald Trump has repeatedly promised — on debate stages and in interviews — that his health care plan would cover "everybody."

"I am going to take care of everybody," Trump told 60 Minutes in an interview this past fall. "I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now."

Trump's new health care plan, released in late February, doesn't deliver on this promise.

It would ultimately cause an estimated 21 million people who are currently covered under the Affordable Care Act to lose health insurance coverage, according to a new analysis from the Committee for a Responsible Federal Budget.

Furthermore, CRFB's analysis finds that Trump's plan would be at least $270 billion more expensive than staying the course with Obamacare, because it repeals the legislation's tax increases and Medicare cuts.

Trumpcare would cost more than Obamacare — and cover fewer people

The biggest policy proposal in Trump's health care plan is the repeal of Obamacare. And that would have really significant effects for both uninsured Americans and the federal budget.

Repealing Obamacare would leave an additional 22 million people uninsured, the CRFB analysis estimates using Congressional Budget Office projections. These people would mostly be losing coverage they get through the health law's marketplaces and its Medicaid expansion. Obamacare doesn't offer universal coverage; CBO estimates that in 2018, it will still leave 27 million people uncovered. Still, it outperforms Trumpcare by a lot, because Trumpcare would add 21 million to that group, for a grand total of 48 million uninsured Americans.

About a million of those who lost Obamacare would gain insurance through Trump's proposal to allow insurance plans to sell across state lines. That would, theoretically, allow shoppers in highly regulated markets to gain access to less expensive coverage. (The Upshot's Margot Sanger-Katz has a good summary of this part of the Trump plan here.)

But even with the sale of insurance across state lines, Trump's plan would leave 21 million Americans without coverage.

Then there is the cost side of Obamacare. The health law does spend $1.1 trillion extending coverage to millions of Americans over the next decade. It more than offsets that spending, however, with $660 billion in new taxes and $880 billion in Medicare cuts.

(Center for a Responsible Federal Budget)

This ends up making Trumpcare hundreds of billions of dollars more expensive than Obamacare. Trumpcare raises federal spending $270 billion under dynamic scoring (a model that estimates faster economic growth due to Obamacare repeal). If you use conventional scoring, which does not assume faster economic growth, the cost is $500 billion.

Trumpcare does have a few money-saving provisions, like allowing Americans to import prescription drugs from across the border. But that saves only about $20 billion — a far cry from the taxes and Medicare cuts it repeals.

2012 was an easy year for Republicans to talk about Obamacare. 2016 is harder.

In the 2012 election cycle, it was exceedingly easy for Republicans to talk about repealing Obamacare. The law had passed two years ago, but most of its big provisions — like the expansion of insurance — hadn't yet taken effect. All the people who would gain insurance were just a theory; they weren't actual people with real insurance plans yet.

Now Obamacare is more than a theory. There are 12.7 million people getting coverage through the health law's marketplaces and millions more covered under the Medicaid expansion. There are people using the health care law for primary care visits and surgeries and cancer treatments. This makes any talk of Obamacare repeal much more tangible than it was in the last election cycle — and means Trump's plan is a direct threat to the people who currently rely on the law for coverage.