Is Trumpcare Dead? Was It Ever Really Alive?

Is Trumpcare Dead?
Was It Ever Really Alive?


Senators Mike Lee and Jerry Moran said yesterday that they would not vote for the Better Care Reconciliation Act, effectively killing the legislation.  As anybody who has been following this story would have predicted, President Trump reacted publicly on Twitter on Tuesday morning, vowing to let the ACA marketplace collapse and then rewrite the plan later.

Senate Majority leader Mitch McConnell attempted a quick punt this morning, calling for an immediate Senate vote on the House bill, a trick card that if it worked, would give Republicans two years to work things out.

Unfortunately for McConnell, it probably won’t.

The White House sees the failure as saying more about the political establishment in Washington than itself, which shouldn’t be all that surprising. Caught up in the drama of the Watergate-Russia emails-Trump family narrative, major media outlets like the Washington Post and the New York Times see a historic defeat rather than a temporary setback. That may or may not turn out to be true. Predictably, conservative commentators and the alt-right believe the defeat says more about the mainstream media and the Deep State than it does about the Trump Presidency. For their part, Democrats clearly think they have found their issue and can be expected to continue to exploit it using legislative Viet Cong tactics (attack on social media, melt into the jungle, lob snarky public Molotov cocktails) to punish Republicans and keep the story on the front page.

One thing is clear. Instead of repealing and replacing Obamacare, the GOP now has to rewrite and replace its own plan. Doing that would be difficult under the best of circumstances, but in the current climate in Washington it is difficult to see how it would be possible without a major shift in the political landscape.

All of this is bad news for hospitals and health plans and a frightening development for consumers, although not the really bad news some had feared. The President’s threat to let the insurance marketplace die and then “figure it out” sounds good as a rallying cry to the troops on social media, but is not the kind of thing that investors and CEOs like to hear.  Realistically though, at this point everybody knew that the uncertainty would likely continue through the year (best case) or a year or longer (worst case) as the gridlock in Washington plays out. As depressing and frustrating as it is that the uncertainty will continue, by this point the industry is used to it. Insiders will continue to look for ways to minimize risk and for business opportunities to capitalize on the uncertainty.

Trump’s plan to allow the insurance exchanges to collapse is the kind of confrontational talk Trump and his advisors relish. In theory, the idea could work. There are in fact signs that it already is, as major insurers leave the marketplace and consumers hesitate before committing to expensive insurance policies.  In reality, however, the collapsing exchanges will create a political crisis that is even worse than the current one for the administration, with news cycle after news cycle dominated by stories of terminally ill cancer patients and parents with children with horrible diseases and no insurance coverage. At this point, it will be difficult for the party doing the collapsing to point at the other side and say “It was them. They did it!”

Moderates see some sort of brilliantly crafted compromise as the obvious solution. In any place and time other than Washington in the year 2017 that would probably be the case. Unfortunately, despite what you’re hearing, it probably isn’t going to happen. Extremists on both sides are unlikely to accept anything less than complete and total victory.  With the President on hand to reliably blow up negotiations with ill considered tweets and taunts, all of the pieces are in place to ensure that the  healthcare reform story continues season after season.

If you are a person with a serious pre-existing condition or somebody facing a life threatening health condition, you can be forgiven for feeling extremely unwell right about now. Will you be able to pay for your drug prescriptions next year? Will you even be able to buy insurance coverage next year?  If you are able to buy insurance, will that insurance coverage be worth the paper it is printed on? If by some miracle, you are in fact able to buy insurance coverage, will some insane person take it away from you at some later date in time?

John Irvine is the editor of the Health Care Blog. He can be followed on Twitter at @thcbstaff. He can be reached by email at [email protected]

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32 Comments on "Is Trumpcare Dead?
Was It Ever Really Alive?"

Nov 3, 2017

President Obama gambled when he made the ACA his top priority upon entering office, and won.

President Trump gambled when he made the AHCA his top priority upon entering office, and lost bigly.

Steven Findlay
Jul 20, 2017

The chance of a pivot to a bipartisan effort to stabilize the exchanges is increasing, though perhaps still low. Depends on how votes go this week and next. Below is a slightly modified portion of a THCB post by me from earlier this month, with what ought to be considered in any bipartisan approach:

(1) An 5% or so increase for 2018 in premium tax credits (via the formula) for low-income people
(2) A commitment to enforce the individual mandate while a comprehensive study is conducted of viable alternatives over the next year.
(3) Inducements to insurers to expand into, or come back to, states they have abandoned and to underserved markets. For example: exemption from the ACA insurer tax.
(4) $15 to $25 billion a year for 2 years to states to subsidize insurers for expensive claims, attract new insurers in poorly served areas, and expand enrollment of healthy young and middle aged people.
(5) At least 2 years of funding for the cost saving reduction (CSR) payments—deductible and co-pay help–at $7 to $10 billion per year.
(6) A reinsurance program with a clear fed-state funding formula. A reinsurance program was in the ACA and operated from 2014 to 2016. It defrayed insurers’ costs for outlier claims and reduced premiums by 5% to 10% a year. The temporary program’s termination was one factor in the average 22 percent increase in premiums across the country in 2017. CMS approved Alaska’s waiver for a reinsurance plan this month. A batch of other states are expected to apply. The process should be expedited.
(7) $20 to $30 billion per year for at least 3 years to states to ramp up opioid addiction and substance abuse/mental health treatment.
(8) Additional funding for the nationwide network of community health centers. With a history of bipartisan support, the 1,300 centers serve the medical needs of about 25 million low-income people. Under current law, they will receive about $4 billion in federal funds in 2017. The Senate bill increased that by $422 million. The centers should get double that in each of the next two years.
(9) Revisions to section 1332 of the ACA to make it easier for states to experiment with their insurance systems as long as those experiments are consistent with the ACA’s insurance rules on consumer protections and do not increase the number of people without coverage nor cost the federal government more money. If California, Vermont or Massachusetts want to enact a single payer system with their own money, let them do it. And if some red states want to try some innovative market-based solutions, those should be allowed to go forward.

Jul 20, 2017

“The chance of a pivot to a bipartisan effort to stabilize the exchanges is increasing, though perhaps still low.”

Yes, so low it’s impossible. Any Republican who attempts to do bipartisanship will get killed in their primary where they’re rewarded for behaving badly. The center for Republicans no longer exists as it’s been purged over the years.

Jul 20, 2017


“President Donald Trump’s interview with The New York Times generated plenty of headline-making comments. But his remarks on health insurance, the biggest topic of the week, suggested he didn’t know how it works or how much it costs.

He said:

“So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan.”

The notion of paying $12 a year for health insurance is even less than the $15 per month number Trump floated in an interview with the Economist earlier this year.

“Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance,” he said in the May interview.

The average premium for a single person who gets health benefits from an employer last year was $536 a month, with employees paying an average of 18 percent of the cost while employers pick up the rest, according to data from the Henry J. Kaiser Family Foundation and the Health Research and Education Trust.

Prices are different in the market for people who don’t get health benefits from an employer or a government program ― including those who purchase policies directly, through a broker or a health insurance exchange. For consumers in this health insurance market, the average monthly unsubsidized premium a mid-level “Silver” plan ranges from $364.91 for a 30-year-old to $872.01 for a 60-year-old, according to data compiled by HealthPocket.

All of those numbers, of course, are significantly higher than either figure suggested by the president. This prompted a number of observers to wonder if Trump was confusing health insurance with the life insurance ads that air in heavy rotation on cable news…”


Steven Findlay
Jul 20, 2017

Indeed, there should now be no doubt that DT does not understand much about the health insurance market and has made no effort to be come fully informed. Maybe Putin can explain it to him next dinner they have

Jul 20, 2017

I haven’t found Trump knows anything of value on any policy he’s wants. He certainly has nothing to offer.

I hope the ACA is repealed without replacement. Then we’ll see who regrets voting for Trump.

Jul 20, 2017

The smarmy HHS Secretary Tom Price the other day cracked that we should just do “Repeal” and go back to the good old days pre-Obamacare — insurance denials, rescissions, lifetime caps, no regulation of costs.

BUT, he’ll keep his 70% taxpayer-subsidized FEHB coverage, thank you very much.

Jul 20, 2017

Many Americans who will loose coverage if the ACA is repealed may want what members of congress and their staff get.

Maybe this push for ACA repeal is so MOC can go back to the 70% premium subsidy they were getting when on FEHBP.

Jul 20, 2017

Insurance feeds the pay off of Ponzi scheme with high cost marginal care. Fascinating system but little to do – or at least less than it could do- for helping sick people while feeding frenzy for well people. It is nuts to think of system as fixable; need new not old thoughts

Jul 19, 2017

CBO on Zombie McConnellCare / “Trumpcare”:

“The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Obamacare Repeal Reconciliation Act of 2017, an amendment in the nature of a substitute to H.R. 1628, which would repeal many provisions of the Affordable Care Act (ACA).

According to the agencies’ analysis, enacting the legislation would decrease deficits by $473 billion over the 2017-2026 period (see Figure 1).

CBO and JCT estimate that enacting the legislation would affect insurance coverage and premiums primarily in these ways:

• The number of people who are uninsured would increase by 17 million in 2018, compared with the number under current law. That number would increase to 27 million in 2020, after the elimination of the ACA’s expansion of eligibility for Medicaid and the elimination of subsidies for insurance purchased through the marketplaces established by the ACA, and then to 32 million in 2026.

• Average premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by roughly 25 percent—relative to projections under current law—in 2018. The increase would reach about 50 percent in 2020, and premiums would about double by 2026.

In CBO and JCT’s estimation, under this legislation, about half of the nation’s population would live in areas having no insurer participating in the nongroup market in 2020 because of downward pressure on enrollment and upward pressure on premiums. That share would continue to increase, extending to about three-quarters of the population by 2026…”

Jul 19, 2017

Trump’s latest to Dean Heller: “Nice little Senate seat ya got there. Be a shame if something bad happened to it.”

Jul 19, 2017

What we are learning is, it is easier to give than to take away even when the gift is only perceived in the mind and is not a reality.

The only solution is to figure out a way to lower costs so that we would be giving to all and not taking anything away. That means lower costs which means less government control, not more. It means cost constraint with subtle charity. It means less rent seekers. . …And finally it means that individuals learn to take charge of their own lives.

Jul 19, 2017

No it was never really alive. The GOP Congress has zero interest in repealing Obamacare. For two reasons.

One is that they don’t want to displease their donors, those who support the primary job of any member of Congress, reelection. They fear their big donors (insurance, pharma, hospitals, chamber of commerce, etc) far more than they fear their constituents. Donor class wants Obamacare, so it stays.

Two is that many member of Congress hate Trump and want to see him and his agenda fail. Trump is a threat to the establishment, the status quo. Anything to discredit him. Just observe how few, if any, Republicans are defending Trump on the unending Russian collusion stories.

I expect a repeat performance on tax cuts/reform. Trump’s biggest political opponent is not the Democrats but instead the establishment which is Dems, Repubs, media, Hollywood, academia etc.

Healthcare is playing out in a very predictable way. Only way out, other than letting Obamacare implode, which it is doing, is a two tiered system. Medicaid for all catastrophic coverage as one tier and a totally free market system for self pay and insurance as the other tier.