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Trump does have a health care plan. It would cause millions to lose coverage.

Mick Mulvaney says no one would lose coverage with Obamacare repeal. His White House budget tells a different story.

President Donald Trump speaks to supporters during a rally at the Van Andel Arena on March 28, 2019, in Grand Rapids, Michigan.
President Donald Trump speaks to supporters during a rally at the Van Andel Arena on March 28, 2019, in Grand Rapids, Michigan.
Scott Olson/Getty Images

Top White House officials are making big promises about President Donald Trump’s announcement that the GOP “will soon be known as the party of health care.” But the detailed plan that Trump laid out in his budget a few weeks ago doesn’t deliver on them.

Mick Mulvaney, director of the Office of Management and Budget, claimed on ABC’s This Week on Sunday that no Americans would lose coverage if Republicans repealed the Affordable Care Act and replaced it with their own plan. Sen. Rick Scott (R-FL), who is leading Trump’s health care push, said on Face the Nation that maternity care would be covered.

But nonpartisan analysts expect the opposite. When the Congressional Budget Office looked at the proposed policy, it estimated the plan would cause millions to lose coverage.

The plan would also give states the option to let insurers to return to discriminating against patients with preexisting conditions and allow states to give insurers flexibility in choosing what gets covered (and not covered), like maternity care.

The Trump administration once claimed it had a health care plan, but it didn’t really. Now it does have a plan, but administration officials aren’t telling the truth about it.

Graham-Cassidy, the Trump plan that would cause millions to lose coverage, explained

Last month, the Trump administration released its annual budget — a 148-page document that spells out the type of policies that it would like to become law. In that budget, the White House says it supports “enactment of legislation modeled after the Graham-Cassidy-Heller-Johnson bill proposed in September 2017.”

This is helpful because it gives us a clear picture of what the Trump administration actually wants to see changed in our health care system. We can read the bill that the budget administration references right here and dive into policy briefs that explain how it would work.

Graham-Cassidy-Heller-Johnson (which I’ll shorten as Graham-Cassidy) was a plan put forward at the very end of the Republicans’ health care push in 2017. It would repeal the Affordable Care Act entirely, including consumer protections preexisting conditions and an expansion of Medicaid, that gave millions of low-income Americans coverage. The Obamacare subsidies that 8.8 million Americans use to purchase private coverage on the health law’s marketplaces would cease to exist.

The rules around private insurance would change a lot, in a way that is much less friendly to sicker Americans. The mandate that private Obamacare patients not be charged for preventive care visits would go away. Current limits on out-of-pocket spending for Obamacare enrollees would be abolished too, a change that could be especially challenging for those with costly medical conditions.

In Obamacare’s place, Graham-Cassidy would create something it calls a Health Care Grant Program, which would give states a lump-sum to fund its health care programs. States would also have the option to allow insurers to charge sicker people higher premiums. They could let insurers set higher prices for pregnant women, too (this was common practice before the Affordable Care Act). States could let insurers opt out of Obamacare’s essential health benefits requirements, which currently mandate that health plan cover a core set of services including prescription drugs and maternity care.

States that like Obamacare could try and keep the system running, using the money from their new health care grants. They could keep requiring insurers to charge sick people the same premiums as healthy people, keep the essential benefits package in place, and try to pay for their Medicaid expansion.

But they’ll probably find that quite difficult, because Graham-Cassidy would cut spending on these programs significantly. The Congressional Budget Office analyzed Graham-Cassidy shortly after its introduction. Their report estimates that the legislation would, over a decade, spend $230 billion less on health coverage programs than the Affordable Care Act.

Some states “would find it particularly challenging to reach current enrollment levels using the available subsidies,” CBO concludes.

That sharp cut in funding helps explain why CBO thinks that Graham-Cassidy won’t deliver on Mulvaney’s promise that Americans won’t lose coverage if Obamacare is repealed.

Instead, the nonpartisan agency determined that “if this legislation was enacted, millions of additional people would be uninsured compared with CBO’s baseline projections.” The increase in uninsured would largely come from rolling back the Medicaid expansion. That program, which covers 61 million Americans and has grown significantly under the Affordable Care Act, would face a $1 trillion budget cut over the course of a decade.

The Trump administration isn’t telling the truth about its plan, because the truth isn’t very popular

There’s a reason that Mulvaney isn’t going on a Sunday morning show and telling its host that the Trump budget endorses policies that would lead to millions of Americans losing coverage and that would let states bring back preexisting conditions.

It’s the same reason you don’t see the Trump administration pointing back to this budget that I’m writing about, which officials could do to back up White House adviser Kellyanne Conway’s recent claims that the Republicans’ health care plans are “manifold.”

Preexisting conditions and canceled insurance plans are not, it turns out, very popular. Most Americans, regardless of their political views, think it’s important to not bring back preexisting conditions.

Obamacare has never been very popular. But the ideas that Trump and the Republicans have rolled out over the past two years are even less popular because they take aim at some of the parts of Obamacare that people actually like.

But instead of touting unpopular policies, the Trump administration has simply decided not to tell the truth about them. We saw that during the original Obamacare repeal push. (I remember Tom Price, then Trump’s health secretary, telling CNN that no Medicaid enrollees would lose coverage under repeal, a claim that was demonstrably false.) And we’re seeing it again now.

It would be a disservice to the Trump administration officials to say that they don’t have a health care plan. They quite clearly do. But it’s one that they aren’t telling the truth about, and Americans deserve to know that.

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