Trump missed a big chance to look better than Obama
President Trump’s hatred of the Affordable Care Act is unhealthy for America. It also may be unhealthy for his party.
Department of Justice officials announced this month that they would stop defending the ACA requirement that insurers accept people with preexisting conditions and not charge them more than other patients. The Trump administration claims that because last year’s Republican tax bill ended enforcement of the mandate that most Americans have health coverage or pay a fine, the whole law is unconstitutional.
The administration’s defense of its refusal is absurd. When the Supreme Court upheld the ACA in 2012, the justices ruled the mandate constitutional under the government’s taxing authority. Twenty Republican-led states – including Florida – are using the same illogic to argue against the entire law’s constitutionality.
If those states and Trump succeed, they will kill the pre-existing requirement that Republicans have said they support. Trump would break his promise to protect such Americans. Another casualty of abolishing the law would be the equally popular ability of parents to have children covered under their policies until the kids turn 26.
Naturally, no one in the administration alerted Republicans, even those up for election in swing states and districts. “I certainly do not believe the provision on preexisting conditions is unconstitutional. I don't even understand what the legal argument would be,” Rep. Leonard Lance, R-N.J., told The Washington Post. Democrats have targeted him.
“I have always favored coverage for preexisting conditions,” Lance said, “and will continue to do so.” But will his support matter if Trump disagrees?
Trump’s decision also will destabilize the individual health care market. Uncertainty causes companies to raise rates. Trump surely would blame Democrats, but polls regularly have shown that most Americans would blame him and Republicans for seeking to abolish the law without a replacement.
Though he touts his supposed success in New York City as a builder, Trump as president is more like a wrecking ball. In wanting to obliterate the Obama presidency, however, Trump again could hurt the lower-income voters who provided his margin.
Whether through Medicaid expansion or the ACA marketplace, most Americans who have obtained health insurance under the law tend to be the working poor. They make too much to qualify for Medicaid but not enough to buy coverage without subsidies. They’re too young for Medicare, and their employers don’t offer group coverage.
The opioid epidemic has hit that same slice of the Trump electorate disproportionately hard. For some families, Medicaid offers the only chance at substance abuse treatment. Trump opposes Medicaid expansion. So does his friend, Florida Gov. Rick Scott.
Palm Beach and Broward counties have dealt with opioids since “pill mills” popped up more than a decade ago. The Pew Research Center, however, reports that 90 percent of Americans in rural areas consider drug addiction to be a problem. Those are Trump voters.
Ironically, Trump could outdo his predecessor on health care in a big way if he wanted to focus on policy. Instead, the populist went with the plutocrats.
In May, Trump announced his supposed plan to reduce prescription drug prices. A strong plan would allow Medicare to negotiate drug prices and permit Americans to buy prescriptions from foreign countries. Trump included neither. He proposed vague ideas for letting drug buyers strike better deals.
Perhaps that’s because of whom Trump hired. The Office of Management and Budget official in charge of drug policy previously lobbied for Gilead Sciences. In 2014, the company began charging $1,000 per pill for its Hepatitis C drug Sovaldi – the price in India was $4 – and drew bipartisan scorn from the Senate Finance Committee.
Republicans imposed the Medicare negotiating ban in 2003, when they created Part D drug coverage. The Affordable Care Act closed the Part D “doughnut hole,” but Obama cut a deal with drugmakers to not seek price controls in exchange for supporting the law.
Many factors explain why health care in America costs more and delivers less than in other countries. One big one is the cost of pharmaceuticals. We don’t use more drugs. We just pay more.
Trump may prefer turmoil in foreign policy, but rattling health care markets with a bogus legal argument won’t help Americans who need certainty. This is terrible policy and Democrats will try to make it into terrible politics for Republicans.
Randy Schultz’s email address is randy@bocamag.com