Trump wants to repeal Obamacare, replace with “worthless” health plan

TRUMP’S HEALTH CARE PLAN IS “WORTHLESS” AND “UNWORKABLE”

• Slate headline: “Donald Trump’s Health Care Plan Is So Bad He Might as Well Not Have One at All.”

• U.S. News opinion headline: “The Stunning Ignorance of Trump’s Health Care Plan: Donald Trump’s proposed alternative to the Affordable Care Act amounts to a whole lot of nothing.”

• U.S. News opinion headline: “The Stunning Ignorance of Trump’s Health Care Plan: Donald Trump’s proposed alternative to the Affordable Care Act amounts to a whole lot of nothing.”

• The Federalist headline: “5 Reasons Donald Trump’s Health Plan Is Worthless: Donald Trump’s seven-point health-care plan contains a few promising reform ideas, but overall it’s not a serious proposal to replace Obamacare.”

• New York Times headline: “Donald Trump’s Health Care Ideas Bewilder Republican Experts.”

• Brookings senior fellow Henry Aaron: “Trump’s proposed alternative to the Affordable Care Act is even worse than his criticism of it.” He would retain the highly popular provision in the act that bars insurance companies from denying people coverage because of preexisting conditions, a practice all too common in the years before the health care law. But he would do away with two other provisions of the Affordable Care Act that are essential to make that reform sustainable: the mandate that people carry insurance and the financial assistance to make that requirement feasible for people of modest means. Without those last two provisions, barring insurers from using preexisting conditions to jack up premiums or deny coverage would destroy the insurance market. Why? Because without the mandate and the financial aid, people would have powerful financial incentives to wait until they were seriously ill to buy insurance. They could safely do so, confident that some insurer would have to sell them coverage as soon as they became ill. Insurers that set affordable prices would go broke. If insurers set prices high enough to cover costs, few customers could afford them.”

• Brookings senior fellow Henry Aaron: Donald Trump’s health care plan is “either the fraudulent offer of a huckster who takes voters for fools, or clear evidence of stunning ignorance about how insurance works.” “In simple terms, Trump’s promise to bar insurers from using preexisting conditions to screen customers but simultaneously to scrap the companion provisions that make the bar feasible is either the fraudulent offer of a huckster who takes voters for fools, or clear evidence of stunning ignorance about how insurance works. Take your pick.”

• Brookings senior fellow Henry Aaron: Donald Trump’s health care policy pronouncements are “notable for their detachment from fact and lack of internal logic.” “Based on his previous flexibility, Trump’s here-today proposals may well be gone tomorrow. As a sometime-Democrat, sometime-Republican, sometime-independent, who is now the leading candidate for the Republican presidential nomination, Trump has just issued his latest pronouncements on health care policy. So, what the hell, let’s give them more respect than he has given his own past policy statements. Perhaps unsurprisingly, those earlier pronouncements are notable for their detachment from fact and lack of internal logic.”

• Brookings senior fellow Henry Aaron: Donald Trump’s given reasons for calling for repeal of the Affordable Care Act are all “clearly and demonstrably false.” “The one-time supporter of universal health care now joins other candidates in his newly-embraced party in calling for repeal of the only serious legislative attempt in American history to move toward universal coverage, the Affordable Care Act. Among his stated reasons for repeal, he alleges that the act has ‘resulted in runaway costs,’ promoted health care rationing, reduced competition and narrowed choice. Each of these statements is clearly and demonstrably false. Health care spending per person has grown less rapidly in the six years since the Affordable Care Act was enacted than in any corresponding period in the last four decades. There is now less health care rationing than at any time in living memory, if the term rationing includes denial of care because it is unaffordable. Rationing because of unaffordability is certainly down for the more than 20 million people who are newly insured because of the Affordable Care Act. Hospital re-admissions, a standard indicator of low quality, are down, and the health care exchanges that Trump now says he would abolish, but that resemble the ‘health marts’ he once espoused, have brought more choice to individual shoppers than private employers now offer or ever offered their workers.”

• Slate’s Jordan Weissmann: Donald Trump’s ideas about health care are “bankrupt.” “And there you have the problem in a nutshell. Donald Trump has barely even proposed a credible conservative vision of health reform. Instead, he’s now on the record with the bankrupt idea that we should repeal Obamacare and replace it with virtually nothing at all.”

• Health policy expert: “Trump’s cure for American health care might well be worse than the disease.” “So, to sum up Trump’s seven-point health care plan, points 2, 3, 5, and 7 are either meaningless or bad ideas, point 4 is probably a good idea, point 6 is genuinely great (but not unique to Trump), and point 1, repealing Obamacare, is only a good idea if you replace it with something better. Based on what Trump has put forth, combined with his past support for government-monopoly health-care programs like the United Kingdom’s, Trump’s cure for American health care might well be worse than the disease.”

• Free-market health policy advocate: Donald Trump needs to “discard” his “damaging and unworkable” ideas and “flesh out” others. “Grace-Marie Turner, the president of the Galen Institute, a champion of free-market health policy, said Mr. Trump’s proposals were sketchy and inadequate. ‘He has to discard some of his ideas, like the importation of prescription drugs, because they would be damaging and unworkable,’ Ms. Turner said. ‘And he has to flesh out his other proposals with much more detail if he hopes to persuade voters that he has a credible plan to replace Obamacare.’”

  TRUMP’S PLAN WOULD ADD TO THE DEFICIT

• CRFB analysis: Donald Trump’s health care plan “would both add to the deficit and significantly reduce coverage.” “As our analysis above shows, Mr. Trump’s plan to repeal and replace Obamacare – based on the details available – would both add to the deficit and significantly reduce coverage. Meanwhile, his plan to block grant Medicaid could generate significant savings; however, insufficient details are available to estimate if there are any and how much.”

• CRFB analysis: Donald Trump’s health care plan would cost $330 billion when factoring in faster economic growth and $550 billion under conventional scoring. “By our estimates, Mr. Trump’s plan to repeal and replace Obamacare would cost roughly $330 billion over ten years including estimates of faster economic growth, and $550 billion under conventional scoring.”

• CRFB analysis: Donald Trump’s plan to repeal the Affordable Care Act would cost $480 billion, or $260 billion including the economic benefits of repeal. “The largest component of this estimate comes from the ‘repeal.’ The campaign website proposes to ‘completely repeal Obamacare,’ which we assume to mean repealing the Affordable Care Act’s regulations, subsidies, Medicaid expansion, Medicare savings, and tax increases. Although repealing the coverage provisions would save about $1.1 trillion, based on Congressional Budget Office (CBO) estimates (adjusted for recent legislation and changes in the budget window), repealing the legislation’s tax increases and Medicare cuts would cost a combined $1.6 trillion. In total, this means repeal would cost $480 billion – or $260 billion including the economic benefits of repeal.”

• CRFB analysis: Donald Trump’s plan to replace the Affordable Care Act would cost $70 billion. “Meanwhile, Mr. Trump’s plan to replace Obamacare would entail further costs. Most significantly, Mr. Trump would create a tax deduction for individuals buying their own health insurance. This would equalize the tax treatment between individually-purchased and employer-provided health insurance, but at a cost of roughly $100 billion over ten years. The cost of these policies would partially be offset by savings from expanding prescription drug importation and re-importation and allowing people to purchase insurance across state lines. Policies to require price transparency and promote health savings accounts will likely have small effects in opposite directions, roughly canceling each other out. As a result, the replacement plan would cost $70 billion.”

• CRFB analysis: Despite Donald Trump’s claims, savings from negotiating aggressively for Medicare drugs would be “small or negligible.” “Note that this analysis does not include Mr. Trump’s call to negotiate aggressively for Medicare drugs, a policy that is not listed on his website. He has previously claimed that $300 billion a year could be saved through negotiation, a claim we rated as false because Medicare will only spend an average of $111 billion each year on prescription drugs. Based on previous estimates by CBO, actual savings would likely be small or negligible.”

  TRUMP’S PLAN WOULD INCREASE UNINSURED RATE

• Slate’s Jordan Weissmann: “No amount of duct tape and gold leaf is going to fix the giant gash Trump would leave in the health care system.” “The problem is that none of this would really expand health coverage much. In late 2008, the Congressional Budget Office concluded that letting Americans shop for cheap insurance across state lines would merely reduce the number of uninsured by about 400,000. Tax deductions would help another 700,000. The CRFB looks at those two figures and concludes that Trumpcare would only help 1.1 million people get insurance. The ranks of the uninsured would swell from 27 million uninsured, as currently projected, to 48 million. Trump’s website does say it would ‘review basic options for Medicaid’ to make sure ‘no one slips through the cracks.’

• CRFB analysis: Donald Trump’s health care plan “would cause almost 21 million people to lose their insurance coverage, as the replacement health care policies would only cover 5 percent of the 22 million individuals who would lose coverage upon the repeal of Obamacare. This would almost double the number of Americans without health insurance.”

• CRFB analysis: Donald Trump’s plan to replace the Affordable Care Act would “only cover about 5 percent of individuals that would lose coverage from Obamacare repeal.” “According to CBO, about 27 million Americans will lack health insurance coverage in 2018. Repealing Obamacare would increase that number by 22 million, whereas Mr. Trump’s replacement plan would only increase coverage by 1.1 million. In other words, the plan would increase the number of uninsured individuals by about 21 million and only cover about 5 percent of individuals that would lose coverage from Obamacare repeal.”

• CRFB analysis: Donald Trump’s call to require insurance companies to cover people with pre-existing conditions without including penalties or subsidies would increase the uninsured rate. “Note that these estimates do not account for Mr. Trump’s call to require insurance companies to cover individuals with pre-existing conditions – a policy not listed on his website. Doing so without penalties or subsidies to encourage individuals to purchase insurance, according to CBO, would actually further increase the number of uninsured individuals.”

• Former George H. W. Bush Medicare administrator: There is “nothing” in Donald Trump’s health care plan that would replace coverage lost in the repeal of the Affordable Care Act. “‘If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,’ said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. ‘There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.’”

• Health policy expert: Donald Trump’s plan to make individuals’ insurance premiums tax-deductible without including tax credits would cause many more people to “slip through the cracks.” “This is a fine idea as far as it goes—after all, the unlimited tax deductibility of employer-sponsored coverage is a relic from World War Two price controls. The problem is that simply allowing individuals to deduct premiums from their taxes doesn’t go far enough. The reason Obamacare offers a refundable tax credit, not merely a tax deduction, is that a lot of people can’t afford premiums to begin with. In theory, because refundable tax credits are an up-front payment, individuals can use them to pay for premiums they could not otherwise afford. Obamacare, however, didn’t make the affordability problem go away, it made the problem worse. That’s why almost every major Obamacare repeal and replace plan (including Rubio’s) has included some form of refundable tax credit for those who don’t have coverage through an employer. Whether this is the best way to ensure coverage is debatable, but almost no one thinks that tax deductibility alone would enable poor Americans to purchase coverage, even if Obamacare were repealed. Without tax credits, the result instead would be that a great many people would “slip through the cracks,” which is precisely what Trump says he wants to avoid.

  TRUMP’S PLAN WOULD NOT LOWER COSTS

• Slate’s Jordan Weissmann: Because some parts of the country are healthier than others, letting insurance companies sell across state lines might not have much effect on costs. “Why are Trump’s two big health-reform ideas ineffective? Letting Americans buy across state lines sounds like a great, pro-market health care fix in theory—simply push aside lots of burdensome state regulations and let competition drive down prices. The problem is that regulations aren’t the only reason insurance prices vary so much from state to state; some parts of the country are simply older and less healthy than others. So the gains of letting someone in highly regulated New York shop in Alabama might not be that great.”

• Slate’s Jordan Weissmann: Letting young people buy cheap insurance would make coverage less affordable for older and sicker Americans. “Letting younger Americans buy super inexpensive insurance would have the perverse effect of making coverage less affordable for sicker and middle-aged customers, whose plans would no longer be subsidized by premiums from a bunch of hale twentysomethings.”

• Slate’s Jordan Weissmann: Allowing people to buy insurance across state lines would do nothing to protect people with pre-existing conditions. “And, of course, creating an interstate market would do nothing to ensure that people with pre-existing conditions, who were often denied coverage pre-Obamacare, could find insurance.”

• Slate’s Jordan Weissmann: Donald Trump’s proposal to make insurance premiums tax-deductible would not provide much benefit unless customers spend a lot on insurance in the first place. “Making insurance premiums tax-deductible similarly comes off like a useful idea at first, since corporations get the same subsidy when they spend on group coverage. But in order to get much of a benefit from deductions, customers have to spend a lot on insurance in the first place, which makes them less than helpful for cash-strapped families in need of budget insurance. That’s why Republicans like Marco Rubio have suggested offering a set tax credit instead, which would at least guarantee everybody in the individual market a certain minimal level of assistance.”

• Health policy expert: Requiring price transparency, as Donald Trump has proposed, is “trickier than it sounds” and “could result in higher prices.” “But price transparency as a public policy is trickier than it sounds and, depending on how it’s implemented, could be indistinguishable from government price-fixing or could result in higher prices. As employers shift more costs to patients, and new technologies like telemedicine become more widespread, price transparency could happen organically. But a simple government mandate on providers to post their prices isn’t going to enable the kind of competitive shopping that Trump’s proposal tried to achieve.”

• Health policy expert: Allowing consumers to import drugs, as Donald Trump has proposed, “wouldn’t address any of the primary factors driving up drug prices and also wouldn’t lower the cost of drugs.” “What Trump is proposing here is to allow Americans to purchase drugs imported from countries that impose price controls in hopes that it will save money. It’s an old idea that wouldn’t address any of the primary factors driving up drug prices and also wouldn’t lower the cost of drugs. As Scott Gottlieb explained recently at Forbes, any proposal to lower drug costs would need to include a plan to reform FDA rules, government price-fixing programs for Medicaid and Medicare, and reforming the market for generic and branded drugs.”

  TRUMP’S PLAN IS NOT FEASIBLE

• Brookings senior fellow Henry Aaron: By doing away with the individual mandate and insurance subsidies while requiring coverage for preexisting conditions, Donald Trump’s health care plan “would destroy the insurance market.” “But he would do away with two other provisions of the Affordable Care Act that are essential to make that reform sustainable: the mandate that people carry insurance and the financial assistance to make that requirement feasible for people of modest means. Without those last two provisions, barring insurers from using preexisting conditions to jack up premiums or deny coverage would destroy the insurance market. Why? Because without the mandate and the financial aid, people would have powerful financial incentives to wait until they were seriously ill to buy insurance. They could safely do so, confident that some insurer would have to sell them coverage as soon as they became ill. Insurers that set affordable prices would go broke. If insurers set prices high enough to cover costs, few customers could afford them.”

• Former insurance executive: Donald Trump’s proposal to allow insurance companies to sell across state lines would run into logistical and legislative roadblocks. “Many of the proposals Mr. Trump has embraced have been Republican standards for years, such as allowing insurers to sell their products across state lines. In a debate in Houston in late February, Mr. Trump said repeatedly that he wanted to ‘get rid of the lines around the states,’ and he explained: ‘Instead of having one insurance company taking care of New York, or Texas, you’ll have many. They’ll compete, and it’ll be a beautiful thing.’ But Mr. Laszewski, the former insurance executive, said this was no panacea. Before a Texas company could, for example, sell insurance in New York, he said, it would need to establish or ‘rent’ a network of doctors and hospitals to meet the needs of consumers. Moreover, state insurance officials have resisted such legislation, saying it could undermine their power to regulate insurance and their ability to protect consumers.”

  TRUMP’S PLAN IS NOT SERIOUS AND LACKS DETAIL

• Former George W. Bush top health official: Donald Trump’s health care plan is “kind of warmed-over Republican mush.” “‘It’s kind of warmed-over Republican mush,’ said Tom Scully, who was a top health official in George W. Bush’s administration. ‘I just don’t think there’s a whole lot to shoot at.’”

• Former insurance executive: Donald Trump’s health care proposals are “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.” “Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals ‘a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.’”

• AEI health economist: Donald Trump’s health care platform “resembles the efforts of a foreign student trying to learn health policy as a second language.” “Mr. Trump’s health care platform ‘resembles the efforts of a foreign student trying to learn health policy as a second language,’ said Thomas P. Miller, a health economist at the American Enterprise Institute and a harsh critic of President Obama’s health law.”

• Health policy expert: Donald Trump’s proposal to allow insurance companies to sell across state lines is “more of a sound bite than a viable policy reform.” “This is what got Trump into trouble last Thursday. What he meant by ‘get rid of the lines around the states,’ probably, is that he would try to encourage competition by allowing insurance companies to sell plans in any state regardless of that state’s insurance regulations. It’s a familiar proposal that comes up whenever Republicans talk about repealing Obamacare, but it’s more of a sound bite than a viable policy reform.”

• Conservative nonprofit senior fellow: Donald Trump’s “vague plans to repeal the law and replace it with something beautiful and great” would not suffice to uproot the Affordable Care Act. “James C. Capretta, a senior fellow at the Ethics and Public Policy Center, a conservative nonprofit group, said Mr. Trump underestimated how difficult it would be to uproot a law that was now embedded in the nation’s health care system. ‘It took a herculean political effort to put in place the Affordable Care Act,’ said Mr. Capretta, who worked at the White House Office of Management and Budget from 2001 to 2004. ‘To move in a different direction, even incrementally, would take an equally herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.’”

• Former George H. W. Bush Medicare administrator: Donald Trump’s health care proposal is not a “serious plan.” “Gail Wilensky, a health care economist who oversaw the Medicare program for George H. W. Bush, contends Trump’s latest plan still falls short of a credible replacement plan — an issue not unique among the GOP presidential contenders. She points out there’s no attempt to address the elimination of the main ways that Obamacare helps poor people get coverage: the expansion of Medicaid and financial assistance for individuals to purchase coverage through the law’s insurance marketplaces. With 20 million Americans now getting coverage through Obamacare, according to White House figures, ‘you need to do something to help the people who are poor, low-income and lower-middle class to buy insurance or you’re not talking about a serious plan,’ Wilensky said.”

• Health policy expert: “It would be a stretch to call what Trump released [about his health care plan] ‘specifics.’” “It would be a stretch to call what Trump released ‘specifics,’ but at least his seven-point plan gives us a clue about how he thinks about health care and what he might try to do in office.”

• Health policy expert: Donald Trump’s health care plan has “a startling lack of seriousness.” “A point-by-point analysis of his plan reveals a startling lack of seriousness about what’s wrong with our health-care system, why Obamacare made it worse, and what we need to do to fix it.”