The CBO, Always the Skunk at the Garden Party
Why is the Republican Party in its current predicament in health-care policy? A lot of reasons, but a big one is that they now have to explain the tradeoffs of a specific plan when their standard-bearer refused to do so in 2016. On the trail, Donald Trump made sweeping promises about how much better health care would be, with no specifics or ideas about how he was going to get there:
“I am going to take care of everybody,” he told 60 Minutes. “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now…The government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”
“We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
“Obamacare is going to be repealed and replaced. … You’re going to end up with great health care for a fraction of the price and that’s gonna take place immediately after we go in. Okay? Immediately. Fast. Quick.”
“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.”
You can’t keep all of those promises. Some of them are more or less contradictory. You can’t keep Medicaid intact AND repeal Obamacare, because Obamacare expanded Medicaid. If insurance companies cannot charge more for those who have preexisting conditions, it is very difficult to reduce premiums.