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The New York Times interview with the guy currently occupying the Oval Office doesn't just reveal that Trump firmly believes he is the best, smartest, most policy-savvy person ever in the job. It reveals that his grasp of policy is limited to certain catchphrases he's heard people around him mention. That's particularly true when it comes to the Affordable Care Act.
Once again, Trump insists "now we've essentially gutted and ended Obamacare" because "I got rid of" the individual mandate. Do we need to go through this again? Everything else still stands—all the things that makes Obamacare popular still exist—that includes essential health benefits, no annual or lifetime caps on how much insurance will cover in the event of catastrophic illness and preventive health services without an additional copay.
Here's where the interview gets kind of interesting and demonstrates just how dim Trump is. He says "There are people who had very good health insurance that now are paying not to have health insurance. That’s the individual mandate. … They’re not going to have to pay anymore. So when people think that will be unpopular. … It’s going to be very popular. It’s going to be very popular." He means getting rid of the mandate is going to be popular, but then goes on to talk about the executive order he signed this fall directing federal agencies to find ways to expand association health plans, where groups of small businesses can band together to buy insurance for their employees.
So now I have associations, I have private insurance companies coming and will sell private health care plans to people through associations. That’s gonna be millions and millions of people. People have no idea how big that is. And by the way, and for that, we’ve ended across state lines. So we have competition. You know for that I’m allowed to [inaudible] state lines. So that’s all done. […]
Now here’s the good news. We’ve created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. Millions of people. That’s gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that’s a big thing. And the individual mandate. So now you have associations, and people don’t even talk about the associations. That could be half the people are going to be joining up. … With private [inaudible]. So now you have associations and the individual mandate.
I believe that because of the individual mandate and the associations, the Democrats will and certainly should come to me and see if they can do a really great health care plan for the remaining people.
Here's the thing, he might be right not because associations are such a great thing, but because of this: "The clear intent of the executive order is to create a parallel insurance market exempt from many of the consumer protections in the Affordable Care Act," Larry Levitt at the Kaiser Family Foundation explains. "This has the potential to siphon off healthy people with skinnier benefits and cheaper premiums, leaving behind a sicker pool of people under ACA plans."
All the stuff people like about Obamacare won't have to be in these association plans, which because they'll be so much skimpier will be much cheaper. This is a far more insidious threat to Obamacare than getting rid of the individual mandate, as destructive as that is. It's not clear at all whether Trump thinks these association plans are a really good thing and will be hugely popular and should form the basis of reform he can create with Democrats, or if he understands just how destructive they'll be and in that destruction he's going to force Democrats to the table.
Which isn't going to happen. Trump and his fellow Republicans are going to own everything that happens now with Obamacare. Every person who loses their insurance, it will be Trump's fault. Every time a provider refuses someone's insurance, it's Trump's fault. Every time an insurance company refuses to cover a service, it's Trump's fault. He said he'd fix it, and he's just messing it up. There's no way Democrats are going to get involved in that mess.