Donald Trump is not one to dwell on policy specifics. But he’s been particularly vague about his health care plans, promising to repeal and replace the Affordable Care Act, but rarely hinting at how. Early on, he said he’d pass “something terrific” and left it at that. Eventually, he added that “everybody’s got to be covered” and “the government’s gonna pay for it.” On the more concrete side, he’s gestured toward letting people buy plans across state lines to create more competition in the market. He’s also assured voters many times that “we’re going to take care of people that are dying on the street.” Which is kind of him.
But now, finally, Trump seems to be articulating something close to an official repeal-and-replace position. And for the most part, it looks like a generic Republican approach.
During Thursday night’s Republican town hall, CNN host Anderson Cooper asked Trump what would happen to Americans with pre-existing conditions if Obamacare was repealed and the individual mandate (which requires all adults to buy insurance, thus making it affordable for insurers to cover those who are already ill) eliminated. Trump’s response was a little surprising. “I like the mandate,” he said. “OK, so here’s how I’m a little bit different. I don’t want people dying on the streets and I say this all the time.”
Intriguing! Trump, endorsing the deeply, deeply unpopular individual mandate? Tell us more, sir.
Cooper: A person with a pre-existing condition should be able to get insurance?
Trump: Yes. Obama lied when he said you’re gonna keep your plan, you get to keep your doctor. It was a pure lie. Frankly many Democrats went along only because they believed him. He lied 28 times. Twenty-eight times he said it. Twenty-eight times. If that were in the private sector you be sued for fraud. OK? He lied to get the plan through. He got it through and it’s turned out to be a disaster. The wrong people are buying it. You know what’s happening. It’s dead. It’s gonna … look, Obamacare is dead. It’s gonna be repealed, gonna be replaced. But I will say this, Anderson, if we don’t do something quickly you can have a health care problem that you … like you’ve never seen before in this country. Now the new plan is good, it’s going to be inexpensive, it’s going to be much better for the people. But there’s gonna be a group of people at the bottom, people that haven’t done well, people that don’t have any money that won’t be able to be taken care of. We’re gonna take care of them through maybe concepts of Medicare. We have hospitals that aren’t doing well. We have doctors aren’t doing well. You cannot let people die on the street, okay? Now some people would say, “that’s not a very Republican thing to say.” Every time I say this at a rally, or even today I said it, once again a standing ovation. I said, you know, the problem is everybody thinks that you people as Republicans hate the concept of taking care of people that are really, really sick and are gonna die. And that’s not single-payer, by the way, that’s called “heart.” We’ve gotta take care of people that can’t take care of themselves. But the plans will be much less expensive than Obamacare, they’ll be far better than Obamacare, you’ll get your doctor, you get everything you want to get, it’ll be unbelievable. But you’ve got to get rid of the lines. You’ve got to have competition. Those people that are left, we gotta help them live and everybody likes it when I say it, and that includes Republicans and it’s not single-payer. [Bolds mine]
Ok, not so lucid. Concepts of Medicare? For some reason that makes me think of “notes of red cherry.” Thankfully, Trump took to his most effective medium, Twitter, to clarify.
Now we’re getting somewhere. What Donald Trump is describing is a completely ordinary, party-line plan to replace Obamacare.
Step 1: Eliminate the Affordable Care Act, along with all of its requirements regarding what insurers must cover.
Step 2: Allow Americans to buy insurance plans across state lines, which they currently can’t. This will allow them to buy the cheapest possible plans in states with the fewest regulations, thus putting price pressure on the market (while probably leaving a lot of people with fairly threadbare insurance that will be largely useless if they end up sick. If you’re worried that deductibles are too high under Obamacare, just wait for Trump Care.).
Step 3: Expand health savings accounts, so people can cover their own basic expenses, like annual checkups (and maybe some more significant medical bills).
What about having the government pay to take care of the ill? Well, if he wants to stick by that, he could offer a tax credit to buy insurance, much like Marco Rubio has discussed, and possibly create government-sponsored high-risk pools, where people with pre-existing conditions can buy coverage, which Rubio has also suggested. If he does go that route, he’ll be taking a more compassionate stance than Ted Cruz, who doesn’t appear to have any inclination to help the sick.
Point being, Trump seems to be settling for something akin to Republican health care orthodoxy, albeit while promising not to demolish Medicare, and allowing the government to negotiate drug prices (because the man loves nothing more than negotiations). It’s possible, as some pundits have argued, that Trump’s not really wedded to GOP dogma and is just parroting lines that he thinks will win him conservative votes. But so far, he’s toeing the line in some big ways.