Trump could help himself — and ‘Obamacare’
It sounds far-fetched — and would certainly be an audacious move — but President Donald Trump could pull it off. He has already changed course when presented with new information: After all, China is no longer a “currency manipulator,” and NATO is no longer “obsolete.”
In this case, improving the Affordable Care Act would not only be good policy for millions of Americans but would also be farsighted politics for Trump. The obvious obstacles are his repeated claim that the law is a “disaster” and internal Republican Party dynamics. But his endorsement of the House Republican bill last month ended in one of the biggest embarrassments of his first 100 days. And the new attempt this week to revive the effort might have a similar fate. So he shouldn’t let his past criticisms preclude him from pivoting from “repeal and replace” to “repair and rebrand.”
A rebranded Affordable Care Act would be consistent with the vision Trump offered during the campaign. Then, he promised that everyone would be “beautifully covered,” with “much lower deductibles,” and “taken care of much better than they’re taken care of now.” He said he wouldn’t cut Medicaid and would provide coverage for those who can’t afford care.
As former White House aides who worked on the health care law, we remember why reform was desperately needed. Our system was broken, with 50 million uninsured, skyrocketing premiums and no relationship between cost and quality.
That was then. Now we have the lowest percentage of uninsured Americans on record and the slowest rate of inflation in health care spending in 50 years. Medicare beneficiaries have saved $27 billion on prescription drugs, quality of care is improving, and nearly 600,000 unnecessary hospital readmissions have been prevented.
Still, the law isn’t perfect. Too many hardworking families struggle to pay their medical bills, deductibles are often too high, and some insurance marketplaces need more competition.
The original House Republican bill would have made these problems worse. Premiums would have spiked for most families in the individual market (especially for older people), 24 million would have lost coverage, and over $800 billion would have been cut from Medicaid, a program that provides lifesaving help to severely disabled children, the frail elderly and the poor. Given this, Mr. Trump’s support for the House bill was baffling. And the latest version — which tries to reflect the House Freedom Caucus principle that the federal government should have no role in health insurance — moves even farther from his campaign promises.
The answer to the law’s shortcomings isn’t repeal. Many House Republicans are caught in a classic “inside the Beltway” dynamic — the more they repeat the repeal rhetoric, the more converted they become to the cause. But that self-perpetuating loop isn’t the country’s reality.
There’s still a winning hand for President Trump on health care, but it’s not the one he’s playing. “Repair and rebrand” would take advantage of Trump’s background as a businessman and his interest in expanding the private sector. What the Affordable Care Act needs most is more customers — and federal officials taking actions to increase enrollment, strengthen private plans and ensure the marketplaces will function properly. With a few smart adjustments, this will foster a virtuous cycle of lower costs and expanded competition and coverage options for millions of working-class voters.
First, Trump should eliminate any doubt that the cost-sharing subsidies that limit out-of-pocket expenses for over 8 million Americans and stabilize the insurance markets will continue. He can do this by continuing to fund the subsidies through existing authority and by fighting a House Republican lawsuit challenging the program. Another alternative would be to support a bipartisan, permanent legislative proposal.
Second, he should make clear that he will faithfully execute the law and instruct his secretary of health and human services, Tom Price, to maximize enrollment efforts and finalize rules that improve affordability, instead of undermining coverage. That will give insurers the confidence to stay in the marketplaces and lower premiums.
Third, Mr. Trump should use his singular marketing skills to highlight the very real benefits of coverage. Past enrollment efforts have been constrained by insufficient resources and partisan attacks. Mr. Trump can create innovative ways to persuade people to enroll. Increasing enrollment will bolster private plans and marketplaces that are lagging, and potentially make insurance cheaper in many states.
Finally, the president is well positioned to persuade governors and legislatures in the 19 states that haven’t expanded Medicaid — almost all of which he won in the election — to cover four million more people. This would bring billions in benefits to their hospitals and help combat the opioid crisis.
By keeping faith with his own voters, Trump has an opportunity to combine good substance with good politics.
Nancy-Ann DeParle, a deputy chief of staff for policy for President Barack Obama, is a partner in Consonance Capital Partners, a health care-focused private equity firm. Phil Schiliro, director of White House legislative affairs from 2009 to 2010, is a managing director of Schiliro Barnett, a consulting firm. He lives in Santa Fe. This was first published in The New York Times.