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Trump’s 2020 health care gambit is worse than we thought

I imagined the “hey, let’s talk about Obamacare again!” was going to go badly for President Trump and Republicans. I underestimated the problem.

Trump issued a trio of tweets last night declaring a GOP health care plan to be in the works for a vote by a presumably Republican Congress after the 2020 election. It’s bad enough such a claim gives every Democratic candidate for President or Congress an obvious invitation to replay 2018 by running against the GOP on health care in the coming months. But Trump is making claims about that the plan will accomplish that are Obama-like in their detachment from reality.

Key among them:

“Far lower premiums” and deductibles than Obamacare? Like “if you like your plan you can keep it” or worse, the laughable claim Obamacare would reduce family premiums by $2,500 annually?

Setting oneself up for the same type of easily predictable broken promise would seem not great, Bob. But, we’ll get back to that in a minute.

First, let’s explore what the magical magical, mystery plan being conjured up now by some on the right — a mere 9 years after the signing of Obmacare into law — looks like:

Oh boy. I like Mitt. A lot. But I’m not sure it’s good to have him out front politically on this one.

Either way, the block-grant structure of Graham-Cassidy shows the GOP hasn’t learned the lesson from getting burned by Repeal & Replace in 2017. And bear with me hear because I’m talking about political reality, not an ideological wish list one way or the other for designing part of the health care system:

  1. Most voters aren’t a fan of reducing benefits. One of the key ways to reduce premium costs under Obamacare is to reduce the regulation of benefits, both what must be covered and the richness of that coverage. Thus, states (or anyone) that want to reduce premiums will have to reduce coverage requirements.
  2. Most voters don’t want to discriminant against those with pre-existing conditions. As much as people like Mick Mulvaney want to claim otherwise, a key feature of GOP Repeal & Replace plans has been to allow states to have regulatory regimes where those with pre-existing conditions can be charged more, even if they still have access to coverage.

Those are the two levers to substantially reduce the sticker price of premiums under Obamacare given its regulatory construct. Cut current benefits or mitigate the cost impact of those with pre-existing conditions in the insurance pool. That’s it.

And those are really unpopular with voters.

It can be easy to forget part of the reason Repeal & Replace failed so spectacularly was that it polled terribly. Historically so, and even in many cases with Republicans. Of those two aforementioned levers to reduce premiums, polling found:

Sixty-five percent of those surveyed oppose the AHCA plan to revoke essential benefits.This provision would enable states to allow insurance companies to offer plans that do not include basic benefits required under the ACA — like pregnancy and maternity care, mental health and addiction treatment, and lab tests — thus creating lower-cost plans for consumers. Forty-two percent of Republicans, 86 percent of Democrats, and 60 percent of independents oppose the provision [emphasis added].

More than 77 percent of those surveyed opposed waivers for insurance companies with regard to covering preexisting conditions. Survey responders largely opposed the provision that would allow states to give waivers to insurance companies, enabling them to deny coverage to individuals with preexisting conditions or charge them higher rates for it. Sixty percent of Republicans oppose this provision, as do 93 percent of Democrats and 76 percent of independents.

I’ve been critical of problems on the right with understanding health care policy. Repeatedly so, and said the GOP needs a real plan. Yet, they haven’t show any evidence of getting there with this recent news.

Conservative health care pundit Philip Klein is equally skeptical about near-term GOP hopes:

They don’t care about the details of healthcare policy enough to resolve their differences and unify around any given plan. The only times Republicans can unify is in opposition to Democratic proposals to expand the role of government when they are out of power.

So to is Peter Suderman at Reason:

But one of the reasons that the repeal effort failed in 2017 was that Trump was utterly clueless about the various plans and processes; without presidential leadership to guide them, Republicans couldn’t rally around an idea or even begin to attempt to sell it to the public. But Trump couldn’t be bothered to learn the most basic details about the health care legislation the GOP was attempting to pass, so, again, here we are.

We are, indeed.

One might hope there are some conservative think tank experts toiling away on this topic. Indeed, news reports indicate just such an effort underway:

Heritage Foundation Director of Domestic Policy Studies Marie Fishpaw noted that the president has already included concepts from the Health Care Choices proposal [similar to Graham-Cassidy] in his 2020 budget.

The proposal, according to Fishpaw, “would lower premiums by up to a third, lowering costs while also protecting people with pre-existing conditions.” It would replace federal payments to insurance companies with grants for each state, giving individual states more leeway to determine how to use the money.

Lower premiums by a third?

We’ve gone over this. And it’s clear the think-tankers haven’t solved the issue of policy trade-offs that are deeply unpopular with the public and thus doomed Repeal & Replace.

All of this is no doubt is why Mitch McConnell is taking a hard pass on carrying legislative water on this topic:

Trump’s gambit is a fools errand and the GOP’s best electoral strategy on health care — besides criticizing Medicare for All — is to hope Trump gets distracted and forgets about the issue for the next 18 months.

Indeed, one GOP Senator has figured out insurance coverage is great, but the rising cost of prescription drugs as well as hospital and doctor care are root issues impacting what American spend on health care:

That’s a more prudent political and policy path to go down for now.


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