By Greg Sargent
THE MORNING PLUM:
President Trump’s profound ignorance about policy and the inner workings of our system, and his total disinterest in informing himself about these topics, have produced an unfortunate result: Many of his tweets about matters of substance tend to get ignored as Trump just being Trump. Meanwhile, the viscerally disgusting insults (such as the one claiming Mika Brzezinski bled from her face-lift) make international news.
But Trump’s tweet this morning about health care actually does matter, a lot:
This is getting a lot of attention today, but mainly as a call for Republicans to adopt a particular legislative strategy. As such, it makes little sense: Republicans are struggling to find 50 votes for their current repeal-and-replace bill, with many moderates balking, so it’s hard to see how outright repeal could get a bare majority.
Beyond this, though, it’s worth taking Trump’s tweet as an actual policy statement. Trump has now called for total repeal of the Affordable Care Act, with no guarantee of any specific replacement later, or even a guarantee that any replacement would ever materialize at all.
It’s hard to estimate what would happen if Republicans did act on this and Trump signed it. Republicans probably wouldn’t be able to repeal some key portions of the Affordable Care Act — particularly its insurance-market regulations — via a simple majority “reconciliation” vote. But they could theoretically repeal things with a budgetary orientation, such as the individual mandate and the Medicaid expansion and the subsidies to lower-income people why buy insurance on the exchanges.
We can estimate the impact of repealing those things. Indeed, the Congressional Budget Office has already done so, when it analyzed a previous version of a GOP repeal bill over a year ago. And that analysis found that repealing those things would result in 32 million people losing coverage by 2026, 19 million of them people who would lose Medicaid coverage.
This is unequivocally what Trump has now called for. And it is substantially worse than what is currently being debated in the Senate, which would result in 22 million people losing coverage over 10 years, 15 million of them from Medicaid, per the CBO.
“When Republicans floated their repeal bill back in 2016, CBO concluded that 32 million people would lose coverage, relative to the current baseline, by 2026,” Nicholas Bagley, a health policy expert at the University of Michigan, emailed me today. “Fully 19 million people would be kicked off of Medicaid. Those coverage losses are even grimmer than the losses from the House and Senate bills that are currently under discussion.”
Whether Trump meant this or not, or even knew what he was calling for, are irrelevant. That’s because it could theoretically happen. In fact, conservative senators such as Rand Paul of Kentucky and Ben Sasse of Nebraska are actively calling on fellow Republicans to go forward with repeal alone right now. Sasse doubled down by tweeting an endorsement of Trump’s demand.
Trump, it pains me to inform you, is the president. When he calls on Congress to do something, he is basically saying that he would sign it if they did do it. There is no reason to treat this as trivial or frivolous simply because Trump is an ignoramus and a buffoon. Indeed, Republicans have in fact voted for repeal multiple times in the past. The only reason they aren’t doing so right now is because repeal cannot pass, now that there is a Republican in the White House who would actually sign such a bill. (Yes, Trump would sign such a bill in two seconds. He called for one today, remember?)
In this sense, Trump’s tweet is actually kind of useful. It reveals once again that Republicans have been running a massive scam on Obamacare for years. They constantly fulminated for repeal, and voted repeatedly for it, in the full knowledge that President Barack Obama would veto it and that they would not face the consequences of their rhetoric and vote. The promise of unspecified replacements allowed Republicans to claim they would act to make sure millions didn’t lose coverage, without saying how. But now that repeal could become a reality, they are no longer willing to vote for it, because they would be held accountable for those consequences. By calling for straight-up repeal right now, Trump has inadvertently called their bluff.
Indeed, it’s not even clear that Senate Republicans can pass repeal and replace, because it has become obvious that even this would result in many millions losing health coverage, extracting an immense human toll that is now a genuine possibility. Moderate Republican senators have conceded this to be the case, and their seemingly genuine qualms about this constitute a pleasant surprise. But Republicans who have no serious misgivings about such an awful outcome have resorted, for political reasons, to all manner of lies and obfuscation to obscure this reality.
This includes Trump and the White House, who have dissembled relentlessly about how their plan would leave everybody covered and wouldn’t cut Medicaid at all. But now Trump has confirmed that he is indeed for full repeal, full stop — which would result in 32 million fewer covered — without any guaranteed “replacement” providing any cover to advance the lie that millions wouldn’t lose coverage. Trump has unmasked his own scam.