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Trump and the Republicans in Congress are on a collision course over Obamacare replacements

Trump, Ryan, and Pence Nicholas Kamm/AFP/Getty Images

In his Wednesday interview with ABC News, President Donald Trump doubled down on creating a health care plan much more universal than the Affordable Care Act, telling David Muir that he “wants to take care of everybody.” Here’s the relevant section:

DAVID MUIR: Let me ask you, Mr. President, about another promise involving Obamacare to repeal it. And you told the Washington Post that your plan to replace Obamacare will include insurance for everybody. That sounds an awful lot like universal coverage.

PRESIDENT TRUMP: It's going to be — what my plan is is that I wanna take care of everybody. I'm not gonna leave the lower 20 percent that can't afford insurance. Just so you understand people talk about Obamacare. And I told the Republicans this: The best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and — and the Democrats will vote for it. Believe me.

Later in the interview Trump added this:

Obamacare is a disaster. We are going to come up with a new plan, ideally not an amended plan because right now if you look at the pages, they're this high. We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost.

But here’s the problem: Absolutely none of the plans that Republicans are pursuing on Capitol Hill hit this mark. They do not provide better coverage for more people at a lower cost.

Republican plans generally cover fewer people and offer fewer health benefits

Economic analyses of some of the leading plans, particularly those from House leadership and the Senate Finance Committee, all suggest that millions fewer would have coverage.

There are other plans that haven’t received any economic analysis yet, like the new Cassidy-Collins proposal. It is possible, although not assured, that this particular plan may cover more people than Obamacare because it would allow states to auto-enroll the uninsured in coverage. But, to be clear, this would not be “better coverage” as the term is commonly understood, with more robust benefits and less cost sharing.

The Cassidy-Collins proposal envisions enrolling people into bare-bones catastrophic plans, that are much cheaper for the government to subsidize. These plans wouldn’t have the same benefit mandates the health care law currently sets. Insurers, for example, could decide not to cover maternity or mental health services. That would certainly drive down premiums — but for those who need maternity or mental health services, it’s hard to see how this would seem like better coverage.

Trump’s goals aren’t impossible. He could, as Bloomberg’s Zach Tracer points out, decide to regulate medical prices as a way to deliver care to more people at a lower cost. But those types of price regulations are not on the table at all in the Republican replacement plans. Instead, Republicans have proposed ideas that directly conflict with the type of plan the president is outlining — and at some point, these two ideas are going to collide with each other.

If I had to place my money, I’d bet on the congressional Republicans winning. It’s incredibly unlikely we’d see any medical price regulation, which makes Trump’s vision impossible. Congressional Republicans, meanwhile, have laid out a more realistic plan, even if it’s not quite as politically popular: Spend less money and cover fewer people.

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