Donald Trump faced a question on Obamacare during his press conference Tuesday — and there are two parts of his response that I found especially notable.
The reporter’s question was, “Can you be specific on what guidance you are giving congressional Republicans on the timeline for repeal and replace? Would [a replacement law] guarantee coverage for those who have gotten health insurance through the current Obama care law?”
Trump did not answer the second question — and that is important
Trump gave a lengthy answer to these questions and talked about how his plan would be better and cheaper than Obamacare. But he did not actually answer the question about coverage. He did not address whether the administration’s replacement plan would cover the people who currently depend on the health care law.
This is a question that Republicans are not enthusiastic to answer. I spent yesterday asking the same one to Republican senators; one of them turned around and walked down a hallway when I asked about this particular issue.
The likely reason for that lack of enthusiasm is that the GOP plans that exist right now in Congress would cause millions of people to lose coverage. The number of millions depends on which plan passes.
Trump did say, "We're going to have health care that is far less expensive and far better." No policy has managed to deliver that before because it is an impossible promise. One of the biggest gripes Republicans have with Obamacare is that premiums and deductibles are too high — that for enrollees, coverage feels like it costs far too much.
That’s a problem that is fixable. But more robust coverage — plans with more benefits, lower deductibles, and lower premiums — costs more money. This is one of the difficult decisions that Democrats had to grapple with in the health care law: how much money the government should spend on covering Americans.
In the replacement debate, Republicans are trying to avoid a moment like when President Obama said, in the throes of the Obamacare debate, “If you like your health care plan, you can keep it” — a promise that PolitiFact named its lie of the year in 2013.
But at some point — when the administration sends Congress a bill, or when the Congressional Budget Office scores it — Republicans will have to confront that question. And they’ll have to face a decision: Are they fine with a plan that does not cover as many people as the Affordable Care Act? And if so, how are they going to defend that?
Trump says he and his HHS secretary will work on a plan. That’s an important clue.
Trump, for the first time, gave some procedural clues as to how a replacement plan might come to fruition. He said that “we're going to be submitting as soon as our secretary is approved, almost simultaneously, shortly thereafter, a plan.” This suggests that Trump might steer the replacement process from the executive branch more than we initially thought.
If this does end up being the case, we actually have a lot of clues of what this plan would look like. Tom’s pick for health and human services secretary, Rep. Tom Price, is the author of the most detailed Obamacare replacement I’ve read to date, the 242-page Empowering Patients First Act.
If you’re looking for a replacement plan that isn’t just a white paper — that actually exists in legislative language — this is it. And given that sounds like what Trump is looking for right now, it’s worth going over how the Empowering Patients plan works:
- Empowering Patients restricts — but doesn’t ban — discriminating against people with preexisting conditions. Price’s Empowering Patients plan, like Obamacare, requires insurance plans to offer coverage to all patients regardless of how sick they are. But the Empowering Patients plan, unlike Obamacare, would let insurers charge sick people more if they did not maintain “continuous coverage.” This means that someone who has a break in coverage could face higher, possibly unaffordable insurance rates — although the Price bill does cap premiums for the sick at 150 percent of the regular rate.
- Empowering Patients makes insurance better for people who are young and healthy. It makes insurance worse for people who are old and sick. There are a lot of elements of the Price plan that create new winners and losers. One is that Empowering Patients eliminates Obamacare’s set of “10 essential benefits,” which mandates that all insurers cover a set of 10 different types of care, including maternity services and pediatric care. This is great if you’re healthy (fewer benefits means lower premiums) but crummy if you actually need medical care.
- Price would provide tax credits, but they would help the poor and young less and older and richer people more. Obamacare’s tax credits are based on income, with people who earn less getting more help. Empowering Patients’ tax credits would only be based on age, giving more help to those who are older (and who will presumably be charged higher premiums). This means that Bill Gates would qualify for the largest tax credit simply because he is 61 years old. Under the Empowering Patients bill, Gates’s net worth of $83 billion — presumably enough to purchase health coverage — would do nothing to disqualify him. Under Obamacare, he gets no help. Conversely, a 23-year-old with little income and health problems gets minimal help under Price’s plan — despite the fact that he needs support much more than Gates does.
Price’s plan is the most thorough one that exists right now — but it’s also important to keep in mind that it hasn’t faced any votes in Congress, let alone any committee hearings. It is far from vetted by the Republican Party, but if quick replacement is the goal, then this bill likely provides the best shot.
You can read a more thorough explanation of the Price bill here.