President Donald Trump gave a lengthy interview Sunday morning to CBS’s John Dickerson about the Republicans’ health care plan.
His responses to basic questions — like what provisions the bill includes or how it would change the health insurance system — suggest he either doesn’t understand how the American Health Care Act works, or doesn’t want to tell the truth about it.
Dickerson is the first journalist I have seen grill Trump on what, exactly, is in the Republican plan. He isn’t asking about the politics of the bill and whether it will pass. Rather, he focuses on what are arguably basic questions: What elements are in this bill, and what do you think of them?
Trump stumbles. He says that people with preexisting conditions will be protected. Under the latest amendment to the American Health Care Act — the one that got the Freedom Caucus on board — they won’t be. He says that deductibles will go down under the Republican plan. Nonpartisan analysis expects deductibles would go up.
The health care plan that Trump described on Face the Nation is not the one that the Republican party has offered. His answers suggest an unfamiliarity with basic policy details of a plan that has been public for nearly six weeks at this point — a plan that his administration has pushed Congress to pass.
"Forget about the little shit," Trump reportedly told a room full of legislators during the health care negotiations. "Let's focus on the big picture here."
His answers on CBS suggest that, if he actually read the Republican bill, he would find it sorely disappointing — and at odds with his health care goals.
Trump says the updated GOP plan protects people with preexisting conditions. No, it doesn’t.
Much of the Trump interview centers on Trump claiming that new changes to the Republican health care bill will protect people with preexisting conditions. In fact, it’s exactly the opposite: An amendment to the AHCA introduced this week would give states authority to let insurers charge sick people higher premiums.
Dickerson starts with a relatively simple question that is basically: How will this bill help your supporters? Here is Trump’s response:
Preexisting conditions are in the bill. And I just watched another network than yours, and they were saying, "Preexisting is not covered." Preexisting conditions are in the bill. And I mandate it. I said, "Has to be."
The first iteration of the Republican bill, introduced in the House on March 6, kept Obamacare’s protections for people with preexisting conditions. But a new amendment introduced this week to win Freedom Caucus support changes all that. It caves to conservatives’ demand that to deregulate the insurance industry and let health plans once again use preexisting conditions to set premium prices.
It creates waivers that states can use to let health insurers charge sick patients higher premiums, a practice outlawed under current law.
Trump knows there were changes to the bill. But he gets them backward, insisting that the updates strengthen protections for sicker patients:
This bill is much different than it was a little while ago, okay? This bill has evolved. And we didn't have a failure on the bill. You know, it was reported like a failure. Now, the one thing I wouldn't have done again is put a timeline. That's why on the second iteration, I didn't put a timeline.
But we have now preexisting conditions in the bill. We have — we've set up a pool for the preexisting conditions so that the premiums can be allowed to fall.
Trump is describing the evolution of the Republican plan backward. The protections for those with preexisting conditions have gotten weaker, not stronger. It sounds like Trump may be confusing preexisting conditions with high risk pools — which an amendment last month would have provided $15 billion more in funding for — but it’s hard to tell.
Eventually, Trump becomes insistent that any bill he signs will protect people with preexisting conditions. He appears to throw cold water on that new amendment, the one that won over the support of the Freedom Caucus. He describes it as “in one of the fixes” and that it’s currently “changing”:
DICKERSON: In one of the fixes it was discussed preexisting was optional for the states—
TRUMP: Sure, in one of the fixes. And they're changing it—
DICKERSON: —oh, okay. So it'll—
TRUMP: —and changing.
DICKERSON: —be permanent?
TRUMP: Of course.
DICKERSON: Okay. Well, that's a development, sir.
This part of the interview is a bit bizarre. House Republicans have, at the behest of the White House, been working for weeks now to nail down a bill that their caucus can support. They inched closer to that goal when the MacArthur amendment created the preexisting condition waivers, which clinched the Freedom Caucus’s support.
Now Trump appears to be saying that he’s ready to reverse course, that this part of the Republican bill is currently “changing.” So either Trump is announcing a big policy shift that would likely lead to Freedom Caucus opposing the bill — or he’s misunderstanding what is actually in the bill. From the interview, it’s hard to know.
Trump says things are in the Republican health care bill that aren’t true
This happens a few times. There are a few exchanges like this one, where Donald Trump promises that his bill will lead to lower deductibles than the Affordable Care Act:
Most importantly, we're going to drive down premiums. We're going to drive down deductibles because right now, deductibles are so high, you never — unless you're going to die a long, hard death, you never can get to use your health care.
Deductibles under the Republican plan would not go down. They would go up, according to the nonpartisan Congressional Budget Office analysis. The agency writes that they “expect that individuals’ cost-sharing payments, including deductibles, in the nongroup market would tend to be higher than those anticipated under current law.”
CBO expects that premiums would go down, but that isn’t necessarily great news. Premiums would decline under AHCA because higher premiums for older enrollees would essentially price the elderly out of the individual market. CBO estimated, for example, that a low-income 64-year-old would see her premiums increase 750 percent under AHCA.
There is “no magic,” as Margot Sanger-Katz has written, in how the Republican plan lowers premiums. It does so by making premiums unaffordable for elderly.
Elsewhere, Trump claims that his plan would allow insurance sales across state lines:
TRUMP: We're taking across all of the borders or the lines so that insurance companies can compete—
DICKERSON: But that's not in—
DICKERSON: —this bill. The borders are not in—
TRUMP: Of course, it's in.
Dickerson is right here: Allowing insurers to sell across state lines is a popular conservative policy, but it is not one included in the current Republican bill. It is not included because it likely couldn’t pass as part of a reconciliation bill, where all provisions need to have a direct effect on the federal budget.
Trump does relent on this point when pressed by Dickerson, saying that it will need to pass in a separate bill. But again, he stumbles. He says that bill will get “quickly get approved.” That is incredibly unlikely. Because this bill would need to go through regular order, it needs 60 votes in the Senate — a tall order when Democrats have no interest in working with Republicans on repealing Obamacare.
Trump’s lies matter because voters will believe them
Last December, I reported a story about Obamacare enrollees in Kentucky who voted for Trump. These were generally people who had followed the election closely and knew that Trump promised to repeal Obamacare — the source of their health insurance.
They voted for Trump, however, because he kept promising something better.
Donald Trump made promises during campaign interviews that sharply diverged from his actual campaign stances. He promised, "I am going to take care of everybody,” during an interview with 60 Minutes — even though his campaign health plan would leave 21 million without coverage.
“That man has a head for business,” one enrollee said. “He will absolutely do his best to change things.”
There is a moment where Dickerson presses Trump on how his own supporters would be affected by his own plan. Dickerson seems to be starting to cite CBO data about how premiums could increase by 750 percent for a low-income, older Obamacare enrollee.
He can’t finish his question before Trump begins waving it away:
DICKERSON: So but in the bill, as it was analyzed, there were two problems. One, and you talked about this with Congressman Robert Aderholt, who brought you the example of the 64-year-old who under Obamacare the premiums—
TRUMP: But that was a long time ago, John.
John Dickerson: But has that been fixed?
TRUMP: Totally fixed.
TRUMP: How? We've made many changes to the bill.
No, this problem isn’t fixed. There is no change that House Republicans or the White House have offered publicly that would protect the Obamacare enrollees that are likely to be Trump voters, generally lower-income and older people.
These are still the people who are most vulnerable to high premiums and fewer consumer protections under the Republican health care plan. Young, healthy people could stand to benefit from a less-regulated health insurance market. Insurers would be eager to offer those customers cheap policies.
But older, sicker, and poorer Americans have a lot to lose under the Republican plan. That fact is true whether Trump admits it or not.