Obamacare

Trump Doesn't Understand the GOP Health Care Bill. That's a Barrier to Good Policy.

The president can't negotiate a better bill if he doesn't understand the current one.

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Gage Skidmore / Foter

Over the last two days, President Donald Trump provided more evidence that he doesn't entirely understand the health care bill his administration is urging Republicans to pass. In a one-on-one interview, John Dickerson of CBS News took the sadly unusual tack of asking Trump to explain what was in the American Health Care Act (AHCA). Trump couldn't do it. That's a real problem for those who want to see better policy put in place.

"We've made many changes to the bill," Trump told Dickerson, "We now have preexisting conditions in the bill." Trump made the same claim again when speaking to Bloomberg News on Monday. "I want it to be good for sick people," he told Bloomberg. "It is not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare."

But the recent changes to the bill would have allowed states to obtain a federal waiver to opt-out of community rating, the key regulation governing what are commonly described as Obamacare's preexisting conditions rules. In order to obtain that waiver, states would have to set up a high-risk pool—a government funded insurance plan for individuals with expensive medical conditions—but the Manhattan Institute's Chris Pope notes, those risk pools have historically been underfunded and expensive for enrollees. In addition, as the Cato Institute's Michael Cannon notes, the waivers are structured in a way that would likely accelerate the meltdown of the individual insurance market in states that applied for them. The bill has been changed, yes, but not in ways that add or reinforce Obamacare-style preexisting conditions protections, as Trump claimed.

Trump also told Dickerson that, "We're taking across all of the borders or the lines so that insurance companies can compete," presumably a garbled reference to allowing health insurance to be sold across state lines. On the campaign trail, Trump often repeated the mantra that he wanted to get rid of "lines around the states," though it wasn't clear he fully understood what this meant.

But there's no provision allowing for the sale of insurance across state lines. When Dickerson pointed this out, Trump said that it would be in the "second phase"—which has, in the most charitable interpretation, been described as a series of regulatory changes made by the administration after the primary bill is signed into law.

It is a problem that Trump doesn't understand the bill his administration wants so desperately to pass. It means that Trump can't describe the bill with clarity or accuracy, and that as a result it's impossible to believe what he does say. It also means that Trump doesn't really know what makes the bill good or bad, and how to negotiate towards something better. And it makes the already-difficult politics of health care reform even tougher, since Trump can't effectively haggle over the individual sticking points in a bill he can't describe.

Trump's ignorance was a factor in the failure of the bill back in March. At the time, according to Politico, Trump urged Republicans wary of voting for the bill to "forget about the little shit," and to "focus on the big picture." Those Republicans found it difficult to deal with someone who could not focus on the details that concerned them. In health policy, the big picture is a bunch of little shit.

Trump's continued ignorance about the policy details should worry House Republicans, who are being pressured by the president and his team to support deeply unpopular legislation that the president doesn't himself understand. (That problem will be compounded and repeated if the bill eventually manages to clear the House, because the Senate is all but certain to significantly alter the legislation, and because those alterations are likely to shatter whatever fragile consensus may exist in the House.)

In a way, Trump's inability to understand the bill means that he cannot really be said to support it, or at least that his support is far from stable. Privately, Trump has questioned whether or not the bill is worthwhile. During the initial push to pass the bill, Trump sometimes expressed his anxiety about the bill's merits, according to The Washington Post. He did not possess sufficient understanding of its particular to judge its quality for himself, so he repeatedly asked his aides, "Is this really a good bill?" If you have to ask, the answer is probably no.

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  1. “Trump Doesn’t Understand the GOP Healthcare Bill”

    He doesn’t stand by anything either.
    Unless he smells poontang and he is close enough to grab it!

    President Pud! What a dud!

    1. If you’re finished, the orderlies will help you get some peaches from the cafetorium.

        1. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

          This is what I do.,.,.,., http://www.careerstoday100.com

        2. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

          This is what I do.,.,.,.,….. http://www.careerstoday100.com

        3. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

          This is what I do.,.,.,.,.,.. http://www.careerstoday100.com

    2. Its pretty hard to get his campaign promises passed when the RINOs in Congress are working with DemoRats to keep the government fat and bloated.

      It’s clear that he is trying to get Congress to pass anything relating to Health care and then he will use the HHS to gut the rules.

      You people still cannot figure Trump out can you?

      1. “It’s clear that he is trying to get Congress to pass anything relating to Health care and then he will use the HHS to gut the rules.”

        Why is he waiting for Congress? Doesn’t he know how to use Obama’s pen and phone?

      2. Yes, the same old brainfarts of Republicans.

        The House, Senate, WH, SCOTUS, 25 states of complete control (governor, House, Senate), 31 governorships, 70/99 legislatures ALL GOP.

        But blame the Democrats because you assholes cannot govern shit.

        How’s the trickle-down done right (unlike with Reagan when spending was not controlled) doing in Kansas.

        Brownback, super-super majorities in the House and Senate, and a Republican Supreme Court which can be impeached if anyone renders any legislation unconstitutional. and the state is a disaster. Gone worse in TWO terms.

        But, the party of personal responsibility is sucking the Orange buffoon’s dick and complaining about Democrats.

  2. But there’s no provision allowing for the sale of insurance across state lines. When Dickerson pointed this out, Trump said that it would be in the “second phase”?which has, in the most charitable interpretation, been described as a series of regulatory changes made by the administration after the primary bill is signed into law.

    We have to pass it in order to be able to change it so that it will make any goddamn sense.

  3. Yet again, Trump is held to a standard that no prior president has met. Are we to believe Obama understood the Obamacare bill? How many hundreds of pages? ridiculous

    Executives have advisors, who have sub-advisors, who have topic experts, who have analysts.
    Those analysts and topic experts each understand one small section of a large bill and its impact. The advisors understand the general topics, but focus on the cumulative impact and the interconnectivity of the topics.
    The executive only needs to understand the 1 paragraph summary of the form and purpose…..which is why its called the “executive summary”.

    The issue here, is that the Executive and his administration don’t write the bills. that is held within the congressional offices and their whole separate team of experts and analysts. The administration team doesn’t have time to learn every aspect of the enormous bills and has to rely on the congressional experts and their summaries. Sure, they can pick pieces apart, but at the end the enormity of these bills allows inclusion of all sorts of backdoor crap that the administration may have no real knowledge about.

    1. That is the best argument for local and small government that I’ve ever seen

  4. Been a while since I was in a civics class but doesn’t congress make the laws?

    Perhaps Trump, desperate to fulfill a campaign promise, has placed his trust in the party’s congressional leader “Paul Ryan one of the staunchest and most serious small-government advocates in Congress today”.

    1. The media, including Reason is falling for the big Democrat news that they beat Trump.

      Of course, the 2017 Omnibus spending bill until September has not even reached the House or Senate floor to be voted on. It could be voted down. This does not stop the media from claiming a victory over Trump’s cuts.

      When will people just ignore the media’s comments and pats on their back?

      What I get out of 100 media stories about Schumer kicking ass is that Congress still does not have a budget passed and Trump has not signed or vetoed anything yet.

  5. He hasn’t demonstrated an understanding of anything – even business.

    1. He understood how to beat Hillary ‘Snuke’ Clinton.

      He understands how to get a fairly constitutionalist justice appointed to the SCOTUS even when DemoRats are butthurt.

      1. At some point, just being “not Hillary” isn’t enough.

        1. For most people, that point was around 4 in the morning on November 9. 2016.

          1. +1 cankle.

        2. chemjeff your nevertrumpism isn’t much different than nothillaryism

        3. But that was the choice presented to the American voter: Hillary or Donald.

          We made the right choice. Donald was better than Hillary, and he still is.

          Sad.

          1. Yes, sad, but true! What we have “working” in Washington is our reflection! And, it sure shows the American people are a bunch of morons!

          2. Er, no. He is not

            1. So they would be equally bad? At least Trump put a serious justice on the Supreme Court, not some rubber-stamp judge like Hillary would have installed (similar to Obama).

          3. Better than Hillary was an awfully low barrier … as was better than Trump. One just turned out to be a hair lower than the other.

  6. I find it hard to reconcile how my “we must return individual responsibility in this country” GOP congressman can simultaneously argue, in effect, that Citizen X can smoke for 40 years, not have health insurance, and then demand that his medical bills be covered by the taxpayers when he gets lung cancer.

    1. Make it even simpler: the fact that you’re sick proves you engaged in unhealthy behavior, so no benefits for you.

    2. It’s pretty simple. One of those arguments is a lie.

      Your job as a voter is to figure out which one and, depending on whether you approve of the lie or the truth, vote for or against him.

  7. Obama, on the other hand, read and understood all 3,000 pages of the ACA, as did Nancy Pelosi.

    Trump is such a loser that he is tired of losing.

    Sad.

    1. Nancy Pelosi can read?

  8. At least one Republican understands.

    Republican accidentally tells the truth about GOP health policy

    “My understanding is that it will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, you know, they are doing the things to keep their bodies healthy,”
    Rep. Mo Brooks (R-AL)

    http://www.msnbc.com/rachel-ma…..cy?ref=yfp

  9. I guess this is the part where we pretend Obama wasn’t running around bragging about how he didn’t understand how auto liability insurance works.

    1. You can.

    2. You can.

  10. No, you have this all wrong.

    Drumpf does not care what’s in the bill, he just wants to pass one that he can say was “repeal and replace”

    It can literally just say “Merry Christmas”

  11. Not only are high risk pools expensive, under funded, crappy coverage, they cost more to run. And giving sick people crappy care costs more in the long run.
    This is similar to wanting to privatize Medicare/Medicaid, put someone making a profit in charge, another middleman. The whole middleman to save money concept exists because of our convoluted tax laws. We’ve already got extra middlemen in our healthcare system and while it may let people at the top pocket more money it costs the payers more money which is ultimately you.
    We’re not even talking manufacturing where outsourcing saves by not having to build a new plant with million dollar machines. These middlemen are paper shufflers.
    I’m still waiting for any of the proposed methods for bringing costs down that aren’t already there to be presented from the Republicans. I don’t think the Republican ways to bring down costs exist, they were just good sound bites for the election. Being against Obama/Romney-care was just partisan bickering for votes. Just like ACA was to funnel more money into the corporate owners of the government, the crocodile tears of those owners and ACHA is a way to funnel even more to them. First we all have to give them our money to spread risks. Now we have to not only give them our money but pool the risk and give them even more money so it’s profitable too.

  12. Why Repeal if We are Going to Replace?
    The Constitution does not grant the federal government any authority to meddle in our health care, so it wouldn’t matter even if the Republican replacement plan were a good one.
    In 2014, Gruber candidly declared that the legislation was written in a way that was designed to deceive the American people and to exploit “the stupidity of the American voter.”Let me ask the simple questions: do you believe that government is a truth-teller?
    Do you believe that government intervention in a marketplace makes the market more efficient and just?
    Do you believe that government is the solution to our economic problems?
    If you do, then maybe Jonathan Gruber is right. Maybe you need someone like him, or your favorite political party, to lie to you for your own good.
    The operative clauses to look up here are Article One, Section Eight of the Constitution and the Tenth Amendment. It will only take you about six minutes to read and understand that any replacement of Obamacare is more than just a Republican betrayal for American health care; it is a dangerous and tyrannical trespass into American homes and lives.
    Make no mistake, repealing Obamacare is the Congress’s duty, and to replace it is the action of tyrants.
    http://freedomoutpost.com/why-…..o-replace/

  13. Why Repeal if We are Going to Replace?
    The Constitution does not grant the federal government any authority to meddle in our health care, so it wouldn’t matter even if the Republican replacement plan were a good one.
    In 2014, Gruber candidly declared that the legislation was written in a way that was designed to deceive the American people and to exploit “the stupidity of the American voter.”Let me ask the simple questions: do you believe that government is a truth-teller?
    Do you believe that government intervention in a marketplace makes the market more efficient and just?
    Do you believe that government is the solution to our economic problems?
    If you do, then maybe Jonathan Gruber is right. Maybe you need someone like him, or your favorite political party, to lie to you for your own good.

  14. *sigh* The President’s past history suggests that he is unwilling to delve into anything more than a single page in length, perhaps less than that. He would not read the briefings provided by the existing Security and Intelligence communities.

    So the chance that he will pay attention to the details in anything as complicated as a healthcare bill seems very low.

    And it’s not just healthcare. One basic problem of having government — any level of government — involved in anything is that in the US the government works by rules. Congress specifies the rules that will be applied, or they write some general directions and leave it to the Executive Branch — some agency, an EPA or an FCC or FDA — to fill in the details. I think we all know how well that last works out.

    And in almost _any_ law, the details are what matter. Imagine leaving out a “not” in a law defining murder, or rape, or the antitrust laws. (One problem with the last is that it _is_ so vague. There’s a story about somebody from the FTC talking about antitrust: If you charge more than your competition, that’s price gouging. If you charge less, that’s an attempt to gain a monopoly by undercutting the competition. And if you charge the same amount, that’s price fixing. So no matter what amount you charge, we can get you.)

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