Lost amid the pundits’ applause for President Trump’s calmer demeanor in his speech to Congress Tuesday was a key shift that received far less national attention: the abandonment of promises made by candidate and President-elect Trump on healthcare.
“We’re going to have insurance for everybody,” Trump said in press conference Jan. 11. “We’re going to have a healthcare that is far less expensive and far better.”
Or, as he said in a September 2015 “60 Minutes” interview, “I am going to take care of everybody. Everybody’s going to be taken care of much better than they’re taken care of now.”
{mosads}But the principles the president outlined Feb. 28 throw all those lofty commitments under the bus — and they directly align him with a policy agenda long promoted by the most callous cheerleaders of the “repeal and replace” crowd, that would extinguish coverage and care for tens of millions of Americans and increase the health and economic insecurity of many who voted for this president.
Instead of his prior guarantee that no one would lose coverage gained through the Affordable Care Act, Trump adopted the double speak offered by now Health and Human Services Secretary Tom Price in his confirmation hearings, that Americans with pre-existing conditions will have “access” to coverage.
Yet, as Sen. Bernie Sanders (I-Vt.) aptly noted in that same hearing, “access” to buying expensive private insurance, with no serious plan to rein in skyrocketing out-of-pocket costs, is meaningless. “I have access to buying a $10 million home; I don’t have the money to do that,” Sanders reminded a smirking Price.
The false promise of health savings accounts, which, without any effective constraints on corporate healthcare price gouging, primarily benefit the banking industry and higher income people, not those who can not afford to buy insurance now.
Similarly, the tax credits Trump, Price and company tout will fall far short of keeping up with rising costs. An extensive analysis by the nonpartisan Kaiser Family Foundation March 1 concludes that the average tax credits offered under a House Discussion Draft would be 41 percent less than what the ACA would provide in 2022. A 2015 Price proposal would be even worse: 56 percent less in 2022 and 60 percent lower in 2027.
In short, millions of Americans now covered would be unable to buy the private insurance President-elect Trump promised would be “far less expensive.”
That would apparently not trouble some who mouth the “repeal and replace” mantra a bit less discretely.
As Texas Rep. Mike Burgess (R) indelicately put it at the Conservative Political Action Conference, “If the numbers drop, I would say that’s a good thing.” It would signal “we’ve restored personal liberty in this country,” said Burgess — apparently the liberty to face medical bankruptcy for those who pay for high cost insurance and then try to use it. Or to go without coverage and risk refuting another Trump promise, made on “Fox and Friends” in January when he said “nobody is going to be dying on the streets with a President Trump.”
“Not everybody is going to have health care — some people just don’t care enough about their own care,” scolded GOP Rep. Dennis Ross of Florida in a Bloomberg interview Feb. 24, the heartless Ayn Rand philosophy in a nutshell. If you are not wealthy enough to keep up with the predatory pricing practices of the healthcare industry, we’re happy to discard you.
Millions more would be jettisoned by the goal of rolling back the ACA Medicaid expansion. In his speech to Congress, Trump promised to give state governors the “flexibility” they need. Flexibility is one of those charming code words for plans, long outlined by Price and his fellow ACA opponents, to convert Medicaid into “block grants” or restrained with per-capita caps.
The inevitable result of this scheme is steadily shrinking federal support for Medicaid with a Hobson’s choice for governors, of making up the budget difference or using that “flexibility” to slash eligibility, covered health services or provider payments.
This is the society and shredded safety nets envisioned and so admired by those now in charge in Washington and many state capitols as well. That it sacrifices so many of their fellow Americans to pain and suffering apparently is of little concern.
And if Burgess, Ross and friends think it won’t affect them, think again. Many of those they would happily write off will end up in emergency rooms, rather than doctor’s offices, driving up societal healthcare costs. Others will avoid or delay treatment for contagious illnesses, accelerating the spread of disease outbreaks for flu or worse epidemics.
Certainly, many of the criticisms of the ACA are well earned. Among other gaps, it has left 28 million people still without health coverage, and failed to establish limits on the escalating costs of premiums and other out of pocket fees.
But every proposal advanced by those lusting for repeal and replace would make conditions far, far worse.
Even with the ACA, the U.S. trails other developed nations in a wide swath of health barometers, from cradle (infant mortality) to grave (life expectancy). And that’s before repeal. A 2015 Commonwealth Fund report found that 40 percent of moderate-income Americans with high deductibles already skip needed health treatment, numbers we may look back on in a few years as the halcyon days of yore.
There remains one alternative favored by pre-candidate Donald Trump just two years ago in an appearance with David Letterman, when he recalled the experiences of a friend who became “very, very sick” in Scotland. After he was treated and released, he was told, “there’s no charge,” recalled an amazed Trump, adding, “not only that, he said it was like great doctors, great care. I mean we could have a great system in this country.”
Yes we could, but it would not look like anything Trump, Price, Speaker Paul Ryan (R-Wis.) or others in their caucus have proposed. It would look like another system we already have — Medicare, if we strengthen our healthcare crown jewel — and expand it to cover everyone.
RoseAnn DeMoro, executive director of National Nurses United, has emerged as one of the nation’s preeminent advocates for genuine healthcare reform and working people. Featured in profiles in The New York Times, Wall Street Journal, Los Angeles Times, and Businessweek, DeMoro has also been named “America’s Best & Brightest by Esquire magazine, honored as among “America’s Most Influential Women” by MSN and one of only eight people to be cited among the “100 Most Powerful People in Healthcare” for the past 12 consecutive years by Modern Healthcare magazine. DeMoro also serves as national vice president and executive board member of the AFL-CIO.
The views expressed by contributors are their own and not the views of The Hill.