WASHINGTON ― Republican presidential nominee Donald Trump and vice presidential nominee Mike Pence used the beginning of this year’s Obamacare enrollment period Tuesday to pledge to repeal President Barack Obama’s health care reform initiative next year.
During their separate speeches in King of Prussia, Pennsylvania, outside Philadelphia, Trump and Pence recounted a litany of time-worn conservative attacks on the six-year-old law. Their speeches included some true things, some misleading things and some widely debunked things. The candidates also outlined Trump’s proposals to “replace” the Affordable Care Act.
“When we win on Nov. 8, and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare,” Trump said in his speech at a campaign event one week before Election Day in the battleground of the Keystone State suburbs. “It’s one of the single most important reasons why we must win.”
Their assessment of premiums on the health insurance exchanges was correct ― if partially misleading ― and they were right that Obama’s promises that no one would lose their health insurance plan or have to see a new doctor weren’t fulfilled. But Trump and Pence also trotted out several dubious claims about the Affordable Care Act: The law isn’t “killing jobs,” and it isn’t leading to a rise in part-time employment
Notably, Trump and Pence didn’t offer any recognition of the Affordable Care Act’s achievements, or new details on how their policies would actually replace a law that has led to more Americans having health coverage than ever before.
Trump labeled the law as simply a “catastrophe,” and ran through a litany of talking points about Obama’s broken promises on health care that would be familiar to anyone who’s seen a Republican talking about health care since 2009. Pence made lengthier remarks on health care before Trump, and was preceded by several Republican lawmakers.
As is the norm for Republicans, Trump and Pence completely ignored the Affordable Care Act’s successes while solely focusing on its failures, both real and imagined.
Anyone watching Trump and Pence speak Tuesday would have no idea that the health care law extended health coverage to 20 million previously uncovered people since 2014, bringing the uninsured rate to an all-time low, nor that their plans would eliminate health benefits for roughly as many people.
By contrast, Democratic presidential nominee Hillary Clinton, and Obama himself, hype the parts of the Affordable Care Act that are working but acknowledge its shortcomings, especially when it comes to cost.
Obama’s prescriptions for the health care law align closely with Clinton’s health care agenda, which focus on enhancements to the Affordable Care Act including more generous health insurance subsidies and the creation of a government-run public option program that would compete with private insurers.
Obamacare’s problems are real. The sign-up period for 2017 policies sold on the law’s health insurance exchanges began Tuesday and goes through Jan. 31.
Health coverage next year will be costlier for most, and much costlier for many, and fewer health insurance companies are selling their products on these exchanges after suffering financial losses. The average price for the “benchmark” insurance policies used to set subsidy amounts is going up 25 percent in the 39 states where the federal government runs the exchanges via HealthCare.gov.
Rather than presenting the health care reform law as flawed or incomplete, Trump used cataclysmic language, eliding how few Americans are subject to those rate increases.
“If we don’t repeal and replace Obamacare, we will destroy American health care forever,” Trump said. More than a half-century ago, Ronald Reagan made a similar prediction about Medicare. “One of these days you and I are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free,” Reagan said in 1961.
Premiums on the Obamacare exchanges are unrelated to the cost of the job-based health benefits that cover about half of Americans, or the government programs like Medicare and Medicaid that cover almost everyone else.
In fact, premiums for employer-sponsored health benefits have been rising at lower than historical rates in recent years, and that trend is expected to continue next year. Trump also didn’t mention that the Affordable Care Act’s tax credit subsidies will at least partially shield most exchange customers from the premium hikes.
Trump and Pence are correct, however, that premiums are going up by a lot for those consumers who receive little or no subsidy, that five states and thousands of counties have just one insurer available on the exchanges, and that the Affordable Care Act doesn’t offer any relief to these households.
A review of Trump’s own plans doesn’t indicate he would offer much relief, either, especially to those millions who were uninsured before Obamacare and would be uninsured without it. It’s a far cry from Trump’s February promise: “I will not let people die on the streets for lack of health care.”
Trump, similar to House Republicans, would eliminate health insurance subsidies and replace them with a tax deduction of lesser value and that would be useful mainly to higher-income households.
Likewise, Trump and other Republicans favor converting Medicaid to a “block grant” of money to states, which is equivalent to a massive funding cut. In place of the Affordable Care Act’s guarantee of coverage regardless of pre-existing conditions, Trump calls for a weaker policy that only allows those individuals access to insurance if they’ve never been uninsured before.
(Despite his support for repealing the Affordable Care Act and significantly scaling back Medicaid, Pence, as governor of Indiana, used money from the law to expand Medicaid to more than 400,000 poor Hoosiers. In addition, Indiana is bucking the national trend next year because its average “benchmark” Obamacare premiums are actually going down 2 percent.)
Trump’s purported replacement for the regulated insurance exchanges, where basic benefits are guaranteed and no one can be excluded, is to permit health insurance companies to resume now-illegal practices like excluding people because of their medical histories or charging them more, allowing insurers to raise rates on older people (as a way of reducing rates for younger ones).
Trump also continues to trumpet allowing health insurers based in one state to sell policies “across state lines” ― a line of business the insurance industry isn’t clamoring for and that would result in a rush toward the states that levy the loosest requirements on what insurers must cover, leading to skimpier insurance policies. This policy also would encourage healthy people, who need insurance the least, to flock to insurers in those lightly regulated states, which would remove them from their home states’ insurance pool, causing rates to rise for those who remain.
Another favorite GOP proposal that’s part of Trump’s agenda is expanding the use of health savings accounts, which are tax-free vehicles where money can be set aside for medical expenses. These accounts must be paired with high-deductible health plans, a fact Trump ignores while criticizing exchange coverage for having high deductibles.
Trump may or may not understand any of this, considering his previous statements on health care policy have been all over the place.
Trump wants America to believe he and a GOP-led Congress would move swiftly not only to repeal the Affordable Care Act but to disrupt the status quo and implement something new. That would require a consensus around health policy the Republican Party has been unable to achieve since the beginning of Obama’s presidency.
During his speech Tuesday, he also said he’d call a “special session” of Congress to deal with health care, which is completely unnecessary because Congress already will be in normal session in January.
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