Obamacare

Trump Says Republicans Are Working on a New Health Care Plan. Somehow, Mitt Romney Is Involved.

The new plan is likely to resemble an old plan that was barely a plan at all.

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John Angelillo/TNS/Newscom

Obamacare repeal is back…sort of.

Although Republicans failed to repeal and replace the health care law in a months-long push in 2017, and have signaled in recent months that they were ready to move on—especially since Democrats ran successfully on maintaining Obamacare's pre-existing conditions rules in last year's midterm—President Donald Trump has put repeal back at the center of the GOP's domestic policy agenda.

In a tweetstorm last night, Trump announced that Republicans "are developing a really great HealthCare Plan," that will be voted on after the next election, once Republicans "win back the House."

Trump's tweets follow last week's decision by the administration not to defend any part of the health care law in court, and reports that the White House is working with several conservative think tanks to develop a new health care plan, and that Mitt Romney is also involved in "preliminary discussions."

You may now be thinking to yourself: Mitt Romney? That Mitt Romney? To which I can only answer: Yes, that Mitt Romney.

We all remember how Romney, who, as governor of Massachusetts, passed RomneyCare, a state-based health care system built around an individual mandate, a health insurance exchange, and subsidies for regulated health insurance. At the time, Romney said the plan should be a national model for health care reform. Then Democrats under the Obama administration used the Massachusetts system as a model for their own health care legislation, Mitt Romney ran for president and denied that he actually wanted it used as a model—and, well, here we are, about a decade later, with a national system of subsidies that can be used to purchase regulated insurance on an exchange, known as Obamacare, which Trump is pushing to repeal, with, apparently, Mitt Romney's help. If this were a serialized television show, people would complain that the plot is too complex, and the lore contradicts itself, the characters aren't consistent, and that despite tons of activity, the story never really goes anywhere…and they would be right.

Trump says Republicans are developing a plan to vote on right after the 2020 election. But, as with any of Trump's promises, some skepticism is in order.

The first problem is that Trump's plan doesn't exist. Not only has the White House never put forward a health care plan of their own, Trump has never offered anything other than the barest, briefest explanation of what he would like to see a health care plan do. In his tweets last night, Trump simply says that it will lower premiums and "support Pre-Existing Conditions," which, like "HealthCare" itself, have apparently risen to capital letter status in Trump's mind.

In many cases, it's reasonable for the White House to hang back from the legislative process, letting Congress take charge. But one of the reasons that the repeal effort failed in 2017 was that Trump was utterly clueless about the various plans and processes; without presidential leadership to guide them, Republicans couldn't rally around an idea or even begin to attempt to sell it to the public. But Trump couldn't be bothered to learn the most basic details about the health care legislation the GOP was attempting to pass, so, again, here we are.

That dynamic, and the perception amongst congressional Republicans (including and perhaps especially leadership) that the biggest factor contributing to the party's midterm losses was Democrats campaigning on pre-existing conditions, is one reason why there now appears to be a huge split between Republicans on Capitol Hill, who are wary of putting health care back into play in 2020, and the White House, which is gung-ho about doing so.

On the election merits, Hill Republicans are probably right: A 2020 election about whatever replacement plan the Trump White House dreams up will probably ensure that Republicans remain a minority in the House, rendering this whole exercise moot.

Which bring us to the second problem: The plan the Trump administration settles on, assuming it does, will most likely be a bad plan that pleases almost no one. According to Mitt Romney (yes, still, that one), the new idea that is currently being cooked up is not a new idea at all, but a modification of an old one: Romney told Buzzfeed the forthcoming GOP plan will likely be based on Graham-Cassidy, a last-ditch plan introduced in 2017 that was, itself, only sort of a plan. The short version is that it would eliminate Obamacare's mandatory coverage requirements and take the money that is currently being spent on subsidies and Medicaid under the law and split them up between the states. States could then use that money to fund something like Obamacare (most blue states, presumably) or something else that they come up with later (most red states, presumably).

Almost everyone will hate this plan, including, probably, some people who say they are fine with this plan.

Liberals and defenders of Obamacare will hate it because it dismantles some of the regulatory infrastructure of Obamacare. In particular, it eliminates the health law's essential health benefits—which include things like maternity care—and therefore undermines the law's pre-existing conditions regulations.

Republicans running for reelection in 2020 will hate it, though many will admit this only in secret, in anonymous quotes attributed to "leading Republicans" and terse refusals to discuss the plan at length on the record, because it puts pre-existing conditions back on the table (see above), and Republicans in tight races don't want to run re-election campaigns built around pre-existing conditions.

Republicans from states that expanded Medicaid under Obamacare will hate it because it will almost certainly penalize states that did so by taking that money and splitting it (more or less) equally among states, meaning states that chose not to expand Medicaid would get more, and states that did expand would get less. These Republicans may be coy about the precise reasons, but they will be there, looming in the background of the debate.

Or perhaps the foreground. Among the Republicans who represent an expansion state are Senate Majority Leader Mitch McConnell and Sen. Rand Paul of Kentucky. In 2017, the last time a Graham-Cassidy style block grant was proposed, Paul said he opposed the plan because "It just means you're keeping all the money we've been spending through Obamacare, most of it, re-shuffling it, taking the money from Democrat states and giving it to Republican states. I think what it sets up is a perpetual food fight over the formula."

He's not wrong. Which is why critics of Obamacare are also likely to grumble about this idea as well. A Graham-Cassidy style block grant would merely take the money that's already being spent and redistribute it a different way, to politically powerful states who would lobby not only for more money for themselves, but more money overall. It's not a plan to improve the quality of health care in America so much as a politically contrived policy dodge, allowing Republicans in Washington, who don't agree on much of anything about health care, to say they took down Obamacare while leaving current spending in place—and redirecting a bunch of it toward Republican states.

For all of these reasons, it's hard to imagine that something like this passes, even if Republicans do retake control of the House in 2020, and hold control of the Senate and the White House. In other words, there's no reason to think the underlying dynamic that kept a repeal bill from passing in 2017, when the GOP held all of Congress and the White House, would be different.

This is quite likely to go nowhere, anyway. As Trump ramped up the health care chatter last week, The Washington Post reported that administration insiders knew it was just for show: "White House aides acknowledge that there is no specific plan and that when Trump has said the Republicans need to be the party of health care, it is more of a branding exercise." A branding exercise! Why, it's almost like Trump is someone specializes in sticking his name on hacky, low-quality products he doesn't actually create himself.

But to recap: Trump promises a great new health care plan is on the way, but there's no plan yet, and when there is a plan, it will probably be a bad plan that can't pass. And somehow Mitt Romney is involved.