Last night's debate featured a question from an audience member about the Affordable Care Act, and Hillary Clinton answered first, demonstrating real fluency with health care policy. She talked about the ACA's strengths and weaknesses, and her intention to build on what works.Then it was Donald Trump's turn
. Count the number of times he used the word "lines."
"We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing, because they want -- and President Obama and whoever was working on it -- they want to leave those lines, because that gives the insurance companies essentially monopolies. [...]"Once we break out the lines and allow the competition to come ... President Obama, by keeping those lines, the boundary lines around each state, it was almost gone until just very toward the end of the passage of Obamacare..."
Trump went on to insist that Clinton is pushing a single-payer plan, which is demonstrably wrong, and that Canadians love the U.S. health care system, which is also untrue.But putting that aside, it's clear that Trump had no idea what he was talking about. President Obama doesn't want insurance "monopolies"; he wants the opposite, with exchange marketplaces where insurers compete for consumers' business.But what about these "lines" Trump seemed so excited about? The Republican nominee was trying and failing to explain a bad idea. Let's take a minute to explain what the GOP candidate couldn't.Regular readers may recall that we've discussed
the basic outline of this before -- Trump clearly doesn't read MaddowBlog often enough -- and it's easily one of the Republican Party's favorite health care ideas: we don't need real reform, the argument goes, we just need to let consumers buy across state lines."Obamacare" already allows this, but the law set minimum standards that states must abide by. Trump's vision -- or at least the vision his aides told him to talk about when the issue comes up -- is to remove, or at least severely weaken, those standards.This is generally called the "race to the bottom" for a reason. Under the Republican approach, state policymakers would tell insurers that if they were to set up shop in their state, the rules would be written in the industry's favor. The industry would go with the state that offered the sweetest deal -- which is to say, the most lax oversight with the fewest restrictions -- and before long, consumers' choices would be limited. Why? Because every insurer would move to that state, leaving Americans with no other coverage to buy.That's exactly what happened with the credit card industry, and it's a model to be avoided, not followed.So what's wrong with Obama's approach of minimum standards to prevent this? For consumers and families, nothing. For Trump, to the extent that he understands what he was trying to say, it means burdensome federal regulations intended to protect consumers, which is a problem.The Congressional Budget Office did an analysis
of the idea in 2005, when there was a Republican Congress and Republican White House.
The legislation "would reduce the price of individual health insurance coverage for people expected to have relatively low health care costs, while increasing the price of coverage for those expected to have relatively high health care costs," CBO said. "Therefore, CBO expects that there would be an increase in the number of relatively healthy individuals, and a decrease in the number of individuals expected to have relatively high cost, who buy individual coverage."That is to say, the legislation would not change the number of insured Americans or save much money, but it would make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance. It's a great proposal if you don't ever plan to be sick, and if you don't mind finding out that your insurer doesn't cover your illness.
It's probably not realistic to think Trump would be explore this in any real depth, but that doesn't change the fact that during the debate, he was badly describing a bad idea.