Trump’s Attacks on Health Care Will Backfire

The administration’s chaotic reversals on Obamacare could deprive millions of coverage.

Meanwhile, the administration’s latest budget, released in mid-March, stands behind legislation known as “Graham-Cassidy,” which was pushed by Republicans in 2017 but never won enough support to be brought to a vote.

The Trojan horse of health care reform, the proposal provides for relatively small initial cuts in federal funding and then huge reductions starting in 2027.

According to a Brookings Institution reportGraham-Cassidy would cost 32 million Americans their health insurance by 2027, just as full repeal would. That’s Donald Trump’s idea of a “beautiful,” “terrific” and “unbelievable” health care plan.

.. The administration’s recent decision to submit a brief in a Texas case asking the court to declare all of Obamacare unconstitutional was well publicized.

Slipping by almost unnoticed was Mr. Trump’s instruction last June to the Justice Department, which was defending the A.C.A., to argue instead that certain key provisions — notably, the requirement that Americans with pre-existing conditions be treated equally — be declared unconstitutional.

A win by Mr. Trump in this case could mean that nearly 20 million Americans would lose insuranceaccording to the Urban Institute.

The Individual Mandate Is Here to Stay

The basic economics of U.S. health care makes that easier said than done. Before the ACA, the U.S. stood out from the international pack on health care in two very unpleasant ways. First, it spent a far larger share of gross domestic product on health care. Second, it was the only advanced industrial nation that left vast swaths of its population uninsured. These two doleful facts remain true, although the fraction of Americans without health insurance fell from 13.3% in 2013 to 8.8% in 2017, according to Commerce Department data.

There are several ways to get more people covered. One is to adopt a system in which the government provides or pays for universal coverage—the British or Canadian model. This won’t happen soon in the U.S., not even as Medicare for All.

A second route, advocated unsuccessfully by President Clinton in 1993, is to mandate that every employer provide health insurance to its workers. This approach might seem natural in the U.S. context because so many workers already receive health insurance that way. But the employer mandate has fatal flaws. It wouldn’t cover the nonworking population, and it would impose heavy burdens on small businesses.

For these and other reasons, many economists in the Clinton administration—including me—favored an individual mandate. But that idea was dead in the water in 1993 because it had been advocated by the Heritage Foundation starting in 1989. It was therefore a “right wing” idea.

There are problems with an individual mandate, too. For one, the high cost of U.S. health insurance means that many low- and moderate-income families cannot afford to buy policies on their own. For another, if for-profit insurance companies are made to lose money by covering people with pre-existing conditions, the government must also force young healthy people, who tend to have limited medical expenses, into the insurance pool.

Fortunately, both problems are easily solved—conceptually, that is, not politically—by mandating that everyone buy a policy and providing subsidies to the needy. Massachusetts legislators understood this in 2006. They also knew they were not writing on a blank slate; many citizens received health insurance through their jobs and didn’t want to lose it. Hence the hybrid system that became known as RomneyCare.

If this short description reminds you of the ACA, it should. The two plans are not identical twins, but there is a family resemblance. In 2010 Democrats didn’t follow in the footsteps of Romney Republicans to make them look good; they designed their plan that way because under the constraints of precedent, the underlying logic practically forces you there.

Keep that in mind: If there ever is a TrumpCare, an unlikely proposition, it’s bound to resemble RomneyCare and ObamaCare—no matter what the president claims.

‘Riling Up the Crazies’

As long as I’ve covered politics, Republicans have been trying to scare me.

Sometimes, it has been about gays and transgender people and uppity women looming, but usually it has been about people with darker skin looming.

They’re coming, always coming, to take things and change things and hurt people.

A Democratic president coined the expression, “The only thing we have to fear is fear itself.” But it was Republicans who flipped the sentiment and turned it into a powerful and remorseless campaign ethos: Make voters fear fear itself.

The president has, after all, put a tremendous effort into the sulfurous stew of lies, racially charged rhetoric and scaremongering that he has been serving up as an election closer. He has been inspired to new depths of delusion, tweeting that “Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican.

He has been twinning the words “caravan” and “Kavanaugh” in a mellifluous poem to white male hegemony. Whites should be afraid of the migrant caravan traveling from Central America, especially since “unknown Middle Easterners” were hidden in its midst, an alternative fact that he cheerfully acknowledged was based on nothing.

The word “Kavanaugh” is meant to evoke the fear that aggrieved women will hurtle out of the past to tear down men from their rightful perches of privilege.

Naomi Wolf told Bill Clinton, and later Al Gore, they should present themselves as the Good Father, strong enough to protect the home (America) from invaders.

Donald Trump Is Lyin’ Up a Storm

Is there an election coming up, or something?

With Republicans struggling to keep their grip on Congress, President Trump is dialing up the demagogy. At campaign rallies and on social media, he’s spewing dark warnings about a

  • Democratic mob clamoring to usher in an
  • era of open borders,
  • rampant crime,
  • social chaos and
  • economic radicalism.

As is so often the case, Mr. Trump is not letting reality interfere with his performance. At a rally in Nevada this weekend, the president told the crowd that Californians were rioting to “get out of their sanctuary cities.” (They aren’t.) He also suggested that Democrats will soon be looking to hand out free luxury cars to illegal immigrants. (They won’t.) “Give ’em a driver’s license. Next thing you know, they’ll want to buy ’em a car,” he riffed. “Then they’ll say the car’s not good enough, we want — how about a Rolls-Royce?”

Mr. Trump’s Twitter feed has been electrifying as well, full of statements intended to thrill his fans — and, better still, bait his opponents into a partisan rage. In recent days, he has dubbed Stormy Daniels “Horseface,” escalated his taunting of Senator Elizabeth Warren as “Pocahontas” and grumbled about the fact that Bruce Ohr, one of Mr. Trump’s nemeses in the “rigged” Russian “witch hunt,” is still employed by the Department of Justice. He has asserted that the Democratic nominee for governor in Florida, Andrew Gillum, is looking to turn the state into “the next Venezuela.” He has threatened to dispatch troops to shut down the southern border and renewed his vow to cut off the “massive foreign aid” sent to El Salvador, Guatemala and Honduras for those nations’ failure to stop their people from flocking to the United States.

In particular, the caravan of Honduran migrants making its way north has emerged as a focus of his fantasies. Mr. Trump has repeatedly implied that Democrats are paying Honduran youth to join the caravan. On Monday, he claimed, based on nothing, that the caravan is awash in “criminals and unknown Middle Easterners.”

.. Mr. Trump plays the polarization game because he enjoys it — he does love a brawl — and because he doesn’t appear to care about much beyond his political and personal fortunes. And, more practically speaking, these days he doesn’t have much else to talk about.

It’s not that this president has failed to achieve anything in his first couple of years in office. The economy is chugging along right now, and many Republican candidates would be happy for him to play that up on the campaign trail.

But his most notable achievements do not resonate beyond Mr. Trump’s base. He has overseen a conservative overhaul of the federal judiciary, seating a record number of judges, including two Supreme Court justices. And he has been an aggressive deregulator in areas ranging from education to transportation to health care to the environment.