Some Thoughts on the Trumpcare/GOP Slaughterhouse

FILE - In this Nov. 10, 2016 file photo, President-elect Donald Trump and House Speaker Paul Ryan of Wis., pose for photographers after a meeting in the Speaker's office on Capitol Hill in Washington. For eight years... FILE - In this Nov. 10, 2016 file photo, President-elect Donald Trump and House Speaker Paul Ryan of Wis., pose for photographers after a meeting in the Speaker's office on Capitol Hill in Washington. For eight years, a leaderless Republican Party has rallied around its passionate opposition to President Barack Obama and a rigid devotion to small government, free markets and fiscal discipline. No more. On the eve of his inauguration, Donald Trump is remaking the Republican Party in his image, casting aside decades of Republican orthodoxy for a murky populist agenda that sometimes clashes with core conservative beliefs. (AP Photo/Alex Brandon, File) MORE LESS
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The CBO’s scoring of the Trumpcare, House GOP ‘repeal and replace’ plan is out. And it’s even worse – for people who need health insurance and the GOP – than most were expecting. The CBO estimates that the plan would leave 14 million more people uninsured in 2018, 21 million more in 2020 and 24 million more in 2026.

24 million people. That’s a lot of people.

I’m no expert on the technical scoring issues tied to this kind of estimate. They are in their nature not precise. Maybe the 2026 number would turn out to be 20 million or 28 million people. There is a substantial margin of error. But big picture, the CBO has a very good record of predicting these things. I will only say that this isn’t remotely surprising. In all seriousness, why is anyone surprised?

Obamacare raised money and made various structural changes to insurance provision that lead to millions of people getting health insurance who didn’t have it before. Let’s be clear: who didn’t have it before and in most cases couldn’t get it before. There were some losers in the process. But this is greatly overstated. There were people who were purchasing extremely skimpy coverage who were forced to buy fuller coverage. There were also people high on the income scale who had their taxes raised. But by and large, the idea that people were hurt by Obamacare is mainly bogus.

What Obamacare did do was add millions of people to the health care rolls.

Getting rid of it leads to millions losing their care.

Again, this is not a surprise.

I had seen a number of people – not partisan Republicans but notionally disinterested observers – saying the Trumpcare/House GOP plan actually wasn’t as bad as it might have been. If you go to one of the widgets that allows you to plug in income levels and geography and see how you’re affected, it tells a pretty different, fairly amazing story.

People who have a hard time buying care have their subsidies slashed. Many of those people will go back to not having coverage at all. Meanwhile, in addition to the repeal of taxes on people with high incomes, the new plan actually gives subsidies to millions of people who are fairly well off and can afford insurance already. As many have said, Trumpcare is a tax cut disguised as an Obamacare replacement.

It’s a joke.

On top of that, in addition to the roll back of Medicaid expansion, Trumpcare also fundamentally changes and damages Medicaid itself and paves the way for phasing out Medicare. So the plan actually does more than simply take us back to the 2009 status quo ante.

The plan does generate $337 billion in savings. But that’s not annual. It’s over the decade from 2017 to 2026. In other words, the plan saves a bit more than $30 billion a year for pushing 24 million off the health care insurance rolls.

Last but not least, despite the fact that the plan purports to continue things like a ban on denial of coverage to people with pre-existing conditions, it’s not clear to me at least that it gets enough additional people into the system to make that possible. I’ll leave it to the wonks to figure that one out. My only point is that we shouldn’t take as granted that it continues the parts of Obamacare it says it continues.

With all this, let’s consider some of the President’s promises about what his plan would do.

Donald Trump: “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” 1/15/17

Donald Trump: “Obamacare has to go. We can’t afford it. It’s no good. You’re going to end up with great healthcare for a fraction of the price. And that’s going to take place immediately after we go in. Okay? Immediately. Fast Quick.” (CSPAN, Timestamp 34:23) 2/19/16

Donald Trump: “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, “No, no, the lower 25 percent that can’t afford private. But– … I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” – 60 Minutes, 9/27/15

Donald Trump: “We’re gonna come up with a new plan that’s going to be better health care for more people at a lesser cost.” ABC News, 1/25/17

Donald Trump: “There are people who say everybody should have a great, wonderful, private plan, and if you can’t afford that, and there is a percentage, a fairly large percentage that can’t afford it, then those people don’t get taken care of. That’s wrong. We’re going to take care of that through the Medicaid system. We’re going to take care of those people. We have no choice.” Dr. Oz, 9/15/16

Donald Trump: “The new plan is good. It’s going to be inexpensive. It’s going to be much better for the people at the bottom, people that don’t have any money. We’re going to take care of them through maybe concepts of Medicare. Now, some people would say, “that’s not a very Republican thing to say.” That’s not single payer, by the way. That’s called heart. We gotta take care of people that can’t take care of themselves.” CNN GOP Townhall, 2/17-18/16

Donald Trump: “I’m not going to cut Medicare or Medicaid.” 5/21/15. The Daily Signal.

How to sum this up? When you ditch a bill that lead to a lot of people getting covered, it shouldn’t surprise us that a lot of people lose their coverage.

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