As he has developed a replacement package, Trump said he has paid attention to critics who say that repealing Obamacare would put coverage at risk for more than 20 million Americans covered under the law's insurance exchanges and Medicaid expansion."We're going to have insurance for everybody," Trump said. "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." People covered under the law "can expect to have great health care. It will be in a much simplified form. Much less expensive and much better."
A couple of weeks ago, Politico noted that "fear" was starting to overcome congressional Republicans when it came to health care, and the conversation within the GOP "has definitely shifted" as governing realities took hold.Whereas the party had adopted a "let's-burn-the-joint-down" posture, Republicans are now realizing "how hard it will be to replace the law, and many of them have plainly settled on the fact that they will never be able to craft a plan to insure as many people as Obamacare does."That last part was of particular significance: if Republicans are slowly recognizing the fact that their ACA alternative "will never" cover as many Americans as the Affordable Care Act does, the party isn't just facing a policy challenge; it's also facing a political crisis. Caught up in an irrational crusade against an effective law, GOP policymakers are preparing to sell the public on a plan that will leave millions of Americans behind.But not Donald Trump. No, the president-elect told the Washington Post yesterday that he will overhaul the health care system in a way that won't require sacrifices at all.
Trump is establishing some fairly specific benchmarks: universal coverage, "much lower deductibles," and a simpler and less expensive system in which all Americans are "beautifully covered."If it sounds a bit like the president-elect is describing a single-payer system -- which he used to support until he condemned his own ideas -- you're not the only one who noticed. That said, Trump specifically told the Post, "I don't want single-payer."So how exactly does he intend to keep these promises, which are wildly at odds with his own party's approach to the issue? Trump didn't say, though he insisted the details of his reform plan are nearly complete.It's as if he's never heard of the problem of politicians who over-promise.Look, you don't have to be a health-care wonk to know Trump is establishing benchmarks he simply cannot meet. There is no scenario in which Republicans can create a system with universal coverage and lower deductibles unless they were prepared to dramatically increase government investments into the system.In other words, if GOP policymakers wanted to move "Obamacare" to the left, then maybe it could achieve these goals, but (a) they intend to do the opposite; and (b) even if they did boost health-care spending, they'd run into Trump's related promise to make the system less expensive.Republicans face an uncomfortable choice: they could give up on trying to gut the ACA or they can start owning up to the fact that a whole lot of Americans are going be much worse off under their alternative plan.Instead, the party is led by an incoming president who's publicly making promises he'll never be able to keep. Indeed, he's not alone. Kellyanne Conway recently said no one who currently has insurance should worry about losing it under Trump's approach. House Speaker Paul Ryan (R-Wis.) has made similar comments.Other GOP members of the House and Senate leadership have made related commitments, as have assorted Republicans in both chambers.A variety of other Republicans, however, recognize the dangers of these promises. CNN's Jake Tapper asked Sen. Rand Paul (R-Ky.) yesterday, for example, whether the senator can guarantee that the 400,000 Kentucky residents who've gained coverage through the ACA will remain covered after Republicans are done repealing the law. Paul offered a lengthy answer, which never actually answered the question.A few days earlier, Vox asked Sen. Cory Gardner (R-Colo.) whether the GOP plan will cover as many Americans as the Affordable Care Act. He said he intends to support a plan that will "actually work for the American people." Asked specifically about coverage, the conservative senator "turned around and walked away."This tug-of-war among Republicans, pitting those making unrealistic promises against those afraid of the inevitable backlash, is only getting started. For the GOP, this will get worse before it gets better, and having Trump lead the way with outlandish public assurances will only make the problem worse.