Trump Owns the Health Care Mess

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Trump Maladministration

It’s clear that Trump has no clue how the Affordable Care Act works. But then, few Republicans in Congress do, either, including their alleged policy wonk, Paul Ryan. Trump’s understanding of the health care law probably came from them.

Today Trump explained his reasons for ending the cost-sharing subsidies, a move that will raise everybody’s premiums.

That was a subsidy to the insurance companies and a gift that was what they gave the insurance companies. Take a look at where their stock was when Obamacare was originally approved and what it is today. You will see numbers that if you invested in the stocks, you would be extremely happy. They have given them a total gift. They have given them — you can almost call it a pay off. It’s a disgrace. That money goes to the insurance companies. We want to take care of poof people and people that need help with health care.

I’m never going to get campaign contributions from the insurance companies, but take a look at how much money has been spent by the Democrats and by the health companies on politicians generally, but take a look at the coffers of the Democrats.

The CSR payments have actually brought Republicans and Democrats together. We got calls, emergency calls from the Democrats and I think probably the Republicans were also calling them saying let’s come up with at least a short-term fix of health care in this country. And the gravy train ended the day I knocked the insurance companies’ money. Which was last week. Hundred of millions of dollars handed to the insurance companies for very little reason. Believe me. I want the money to go to the people, to poor people that need it. Not to insurance companies which is where it’s going,  as of last week I ended that.

In other words, Trump seems to think that the payments were some kind of bribe to the insurance industry, not something that paid for an actual benefit.

According to the Center for Responsive Politics, the insurance industry altogether gives a lot more money to Republicans than to Democrats. The biggest health insurance donor, Blue Cross/Blue Shield, in 2016 gave $450,330 to Republicans and $229,840 to Democrats.  The single biggest recipient of insurance industry money in Congress is Paul Ryan.

Donations from insurance industry, 2016, Center for Responsive Politics

The insurance industry (all types) gave more money to Hillary Clinton than to Donald Trump last year, though, which may be one reason he’s angry at them.

The cost-sharing subsidies that Trump axed are different from the tax credits used to buy subsidized insurance, but losing those subsidies will hit everyone hard, especially poor people.

The cost-sharing subsidies were designed to reduce out-of-pocket costs such as deductibles and co-pays for people with incomes from 100 percent to 250 percent of the federal poverty level. About 7 million people are receiving these subsidies in 2017, more than half of the people who buy insurance on the ACA exchanges, according to data from the Kaiser Family Foundation.

Insurers provide the subsidies to consumers, and the federal government reimburses insurers for the higher costs. Those reimbursements are estimated to total $7 billion this year and as much as $9 billion in 2018. At the same time, cost-sharing payments are expected reduce low-income consumers’ deductibles by as much as $3,354 each and out-of-pocket medical expenses by as much as $5,587, reported KFF.

Cost-sharing subsidies are different from the tax credits that qualified consumers receive to help offset the exchange-based premiums. Without the subsidies, medical expenses will become unaffordable for many low-income families, even if they purchase insurance.

Insurers are saying that as a result of the loss of this subsidy they will hike up everybody’s premiums by 20 percent and probably will push a lot of insurers out of the market altogether. The hike will likely be worse for those who buy insurance through ACA. This just in, from Pennsylvania

Obamacare health insurance premiums in Pennsylvania will jump an average 30.6 percent in 2018, nearly four times the increase that had been anticipated before cost-sharing reductions for the coverage were scrapped last week.

The original projection had been for an average 7.6 percent rate increase for individual health insurance plans purchased through the Affordable Care Act’s government exchange.

See also What Affordable Care Act Rollback Means For The Health Care Insurance Industry at NPR.

Whatever happens to health care premiums now, Republicans will own it. Trump will own it. He doesn’t seem to grasp that; last July he actually said,

“I think we’re probably in that position where we’ll let Obamacare fail,” Trump said at the White House. “We’re not going to own it. I’m not going to own it. I can tell you, the Republicans are not going to own it.”

But that’s not something he gets to decide. Ezra Klein says,

Trump’s decision to choke off the federal payments stabilizing premiums and insurance markets is based on a similar theory — bad policy will lead to political pain, which will give Republicans negotiating leverage …

… The problem with this theory is that Democrats no longer hold the White House, or anything else. Republicans, led by Trump, hold total power. They are the governing party, and they stand to absorb the blame for the state of the country. According to an August poll by the Kaiser Family Foundation, by a margin of 60 to 28 percent, Americans now say Republicans are now responsible for the Affordable Care Act.

I agree. People may not understand what Trump did, but they know he did something. And whatever happens to their costs and access to health care from now on, that’s on Trump.

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10 Comments

10 Comments

  1. c u n d gulag  •  Oct 16, 2017 @5:16 pm

    Truman:
    “The buck stops here.”

    t-RUMPLE-THIN-sKKKin:
    “The (giving a) fuck stops ANYWHERE but here!”

  2. Doug  •  Oct 16, 2017 @7:21 pm

    WB, GULAG! – Hope you are feeling frisky.

    Re Health Care after Trump’s decision – “You Break It, You Bought It!”

  3. paradoctor  •  Oct 16, 2017 @9:00 pm

    “Poof” people? As in, he wants them to go poof?

  4. Bill Bush  •  Oct 16, 2017 @9:56 pm

    The low-information voters will beleive Trump on this. He says everything enough times to get through to them.

  5. Ed  •  Oct 16, 2017 @10:26 pm

    He does not own it until “Trumpcare” is a household word more familiar to voters than “Obamacare.” If the Dems do not start repeating this meme one hundred times a day between now and the 2018 midterm elections, they will deserve to lose.

  6. Billikin  •  Oct 16, 2017 @11:02 pm

    Not that Trump understands RomneyCare — it was a Republican idea, after all, and deserves a fitting name. But he is right about it being a subsidy to insurance companies. They keep a higher percentage of payments than they used to, leaving less for actual coverage. If you want to see efficient health insurance in the US, look at Medicare. Trump said, “Believe me. I want the money to go to the people, to poor people that need it.” Well, I don’t believe him, but the logical end point of what he is saying is single payer, or at least much stricter regulation of insurance companies. Which the Republican Congress is not going to provide. Neither is Trump.

  7. priscianus jr  •  Oct 16, 2017 @11:26 pm

    “Believe me. I want the money to go to the people, to poor people that need it. Not to insurance companies which is where it’s going … ”

    Aha! So Trump is for single payer!

  8. Swami  •  Oct 17, 2017 @12:14 am

    I think Trump has been getting lessons in bomb throwing from Newt Gingrich. Trump will never personally own it because his narcissism has a density of such magnitude that he’s impervious to any sense of responsibility. He’s the epitome of a let them eat cake mentality. And his base will never accept the idea that Trump’s callous disregard for the suffering of the economically disadvantaged is anything less than a moral imperative.
    He’s put the issue of destroying Obamacare in the lap of the GOP while retaining the ability to separate from the herd any dissenting voices who favor building upon Obamacare. He’s going to pit them against each other in a process that will guarantee that the repugs will have full ownership of the healthcare mess while he will be able to single out anyone of them as a failure for not fulfilling his promised vision of his health care illusion.

  9. bernie  •  Oct 17, 2017 @9:06 am

    RomneyCare 2.0 it always was, and dated to the time when Obama thought he could get compromises.  Billikan is spot on, as the Brit’s say, on that and the control by the insurance companies.  Do not forget the ad revenue the Drug companies spend on media.  The media does not forget these matters.  Of course they like our representatives cannot be bought or influenced, as they have only the highest of ethical standards.  I feel a coughing fit coming on.  

  10. LongHairedWeirdo  •  Oct 17, 2017 @2:07 pm

    I would argue that plenty of Republicans know how the ACA works. The thing is, it doesn’t matter. They don’t have to know how it works. They can just say it’s failing, imploding, making things worse, etc., and there’s no pushback, no fact check, no political cost, etc..

    Trump can even call the payments a bailout – they’re nothing of the sort! – with no fact check, call out, or push back. The CSR payments are simple. For people at certain income levels, total cost of health care has to be below a certain threshold percentage of income, for the silver plans. Without CSR payments, the price of silver plans would increase for everyone, so the insurance company could afford to pay cost sharing out of pocket.

    In many markets, companies priced policies on the assumption that CSR wouldn’t be paid (even though the law is explicit that they must be paid). This leads to the ridiculous situation where there are silver plans priced higher than gold plans. For people getting subsidies, this can be great news; but it hurts everyone else. An affordable silver plan may now be pushed to a higher price, more than a gold plan. If you get a subsidy, you might get a gold plan for free; but if not, you’re priced out of the market for silver plans.

    One other non-bailout that was called a bailout was a program that redistributed excess profits from insurers making out like bandits to insurers who got hit hard, like the one poor company on the hook for a million a month for one particular person. This isn’t a bailout; it’s a risk reduction so insurers don’t set up their plans to be toxic to people who need expensive care, to avoid getting caught in that sort of situation.

    But hey, post-truth society, and all. What’s really important is not Russian involvement in our elections, not the rank incompetence of Donald Trump, not the fearsome lies by former prosecutors. It’s that the GOP has drummed up a nothingburger, hold the bun, scandal about Hillary Clinton’s e-mail address.



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