Smoke and Mirrors on Health Care

The White House clearly doesn't have a plan beyond attacking Obamacare to score political points.

In the context of Trump declaring he would seek to have the ACA struck down (as James Joyner noted last week), Tthe Acting Chief of Staff had the following to say on Sunday:

Acting White House Chief of Staff Mick Mulvaney claimed Sunday that if the Trump administration succeeds in striking down the entirety of the Affordable Care Act in court, millions of Americans who have health coverage because of the Obama-era health law will not lose their insurance. But with no clear GOP replacement plan, Mulvaney provided few details on how he could make such guarantee.

On “This Week,” ABC News Chief White House Correspondent Jonathan Karl asked Mulvaney whether he could provide such a guarantee for the millions of people who enrolled through HealthCare.gov, including those with pre-existing conditions and the people under the age of 26 enrolled under their parents’ plans.

“Yes and here’s why,” Mulvaney said Sunday. “Let’s talk about pre-existing conditions, because it gets a lot of the attention and rightly so. Every single plan that this White House has ever put forward since Donald Trump was elected, covered pre-existing conditions.”

But beyond pre-existing conditions protections, Mulvaney did not address how the 8.4 million Americans who have coverage through HealthCare.gov and state exchanges would all maintain their coverage under a potential GOP replacement plan.

First, color me shocked he had no details.

Second, of the amazing things about such claims is that they basically consist of an odd formula of getting rid of the ACA while somehow keeping all the good things about it.

This made me thing of Trump’s Tweet from last week:

However, as per WaPo:  For Trump’s ‘Party of Healthcare,’ there is no health-care plan

Senate Republicans, who were caught off guard by Trump’s rapid shift to focus on health care last week, said the White House would need to make the first move by putting forward its own proposal. But administration officials said nothing firm is in the works.

Senate Majority Leader Mitch McConnell (R-Ky.) — acutely aware of the perils that health care poses for Republicans — does not intend to wade extensively into the issue, senators and aides said, even as Trump has revived his fixation on a campaign promise to eliminate former president Barack Obama’s health-care law.

Nor does Senate Finance Committee Chairman Charles E. Grassley (R-Iowa), whose panel would be central to any such debate. When asked whether the two Senate committees overseeing health-care policy are planning to draft a replacement proposal for the Affordable Care Act, Grassley responded flatly: “No.”

“Obamacare is something that’s not going to be replaced unless the courts would declare it unconstitutional,” Grassley said in an interview. “You won’t know that for a long time.”

[…]

That tweet — in which Trump proclaimed “The Republican Party will become ‘The Party of Healthcare!'” — was how McConnell learned the president was interested in taking up the issue again, according to an adviser to the majority leader, who spoke on the condition of anonymity to describe internal GOP interactions.

It is, of course, blatantly obvious that there will be no health care legislation out the current Congress.  Indeed, the ACA was only passed because the Democrats (briefly) had a 60-vote majority in the Senate.

This is one of those areas in which I am simply amazed that supporters don’t see this for the scam that it is or that any self-respecting individual could go out and defend this kind of stuff as a member of the administration.  I understand that all politicians make promises that they may not be able to keep and that they pursue courses of action because their supporters want them to do so, but Trump’s willingness to engage in these kinds of flights of fancy is remarkable.  It isn’t even that they are quixotic, it is they do not make sense after a few moments of basic reflection.  I mean, yes, there is a chance that the ACA could be further eroded in the court (maybe even a chance it would be struck down, although I doubt it).  But the notion that it would be struck down, then replaced with something different (but somehow the same), and that the GOP would become the “Party of Healthcare” is unicorn-ville.

After all, they controlled Congress for two years, and where was the big ACA fix?

I know people cleave to their tribe, but this kind of stuff truly baffles.

FILED UNDER: Health Care, US Politics
Steven L. Taylor
About Steven L. Taylor
Steven L. Taylor is Professor of Political Science and Dean of the College of Arts and Sciences at Troy University. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. rachel says:

    This is one of those areas in which I am simply amazed that supporters don’t see this for the scam that it is or that any self-respecting individual could go out and defend this kind of stuff as a member of the administration.

    I don’t see why you’re amazed at this. These are people who believe that cutting taxes raises revenue despite all evidence to the contrary.

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  2. Mikey says:

    any self-respecting individual could go out and defend this kind of stuff as a member of the administration

    I’m pretty sure “self-respecting individual” and “member of the administration” are mutually exclusive.

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  3. Teve says:

    It isn’t even that they are quixotic, it is they do not make sense after a few moments of basic reflection.

    Neither do the things said here by the Trump Chumps. Basic reflection is for book-readin elitist big city queers.

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  4. Teve says:

    @rachel:

    I don’t see why you’re amazed at this. These are people who believe that cutting taxes raises revenue despite all evidence to the contrary.

    and that we’d have an explosion of jobs and prosperity if only billionaires were allowed to pollute more.

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  5. charon says:

    I know people cleave to their tribe, but this kind of stuff truly baffles.

    There are many people who combine partisanship with gullibility, but not enough of them (I think) to re-elect the dotard.

    I think Trump is worsening, becoming more erratic as his mental health deteriorates. The rest of the White House is just covering for him, but he is uncontrollable.

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  6. charon says:

    Second, of the amazing things about such claims is that they basically consist of an odd formula of getting rid of the ACA while somehow keeping all the good things about it.

    Not necessarily, the claim is often cheaper, which they get to by axing protections. (Axing protections gets downplayed/glossed over, naturally, GOP ever dishonest).

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  7. charon says:

    @Mikey:

    Mick Mulvaney would be a “type specimen” for mendacious hack, unconstrained by principles or scruples. As Trump behavior/craziness gets worse, this is sort of person left in the White House, along with the ideologues pursuing an agenda like Stephen Miller.

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  8. @rachel:

    I don’t see why you’re amazed at this.

    TBH, I do understand that it is silly be amazed at this stuff (and in many ways I am not). Still, the blatant fantasy of all this is stunning.

    These are people who believe that cutting taxes raises revenue despite all evidence to the contrary.

    That has been preached as faith for so long, it does not surprise me. Further, the mechanism is so hidden that I can at least see how people think it might be true.

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  9. gVOR08 says:

    The White House clearly doesn’t have a plan beyond attacking Obamacare to score political points.

    Nor see any need for one.

    You have to see the base’s belief as religious, not rational. If you ask Christians, they believe in eternal life in heaven. As Reynolds likes to point out, they don’t seem any less reluctant to die. When they see a thing as true, it means true to the faith, not true as a matter of objective fact. If you asked them if they believed their sects version of transubstantiation, 99 out of 100 would assert they did, absolutely. If you asked them cold what their sect believed about transubstantiation, I doubt 1 in a 100 could tell you.

    They couldn’t articulate how cutting taxes lowers the deficit any more than they could explain transubstantiation. It’s faith that if we’re virtuous by cutting taxes somehow big fuzzy in the sky, perhaps the invisible hand, will reward us with lower deficits. Whether church going or not, the base are people with a religious bent. They believe Father Trump will take care of them, and screw those other people, and that’s enough.

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  10. Slugger says:

    Recently, Nikki Haley tweeted negative remarks about healthcare in Finland with special reference to childbirth. In fact, Finland’s infant and maternal mortality are much better than the US. This is a model of how our politicians will handle the question of healthcare: just tell the people that they are getting a great deal and avoid any facts. “America’s healthcare is the best in the world, and Trump will make it better.”

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  11. Joe says:

    “Who you gonna believe, me or your own lyin’ eyes?”

    -Chico Marx

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  12. Modulo Myself says:

    This is one of those areas in which I am simply amazed that supporters don’t see this for the scam that it is or that any self-respecting individual could go out and defend this kind of stuff as a member of the administration.

    I’m not. Also, plenty of Trump’s supporters are great with cutting health care for the poor and people outside their shitty middle-American gated communities. They’re also fine complaining about being called heartless by the coastal elites who have rejected them. This is a win-win for them.

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  13. Kathy says:

    Senate Republicans, who were caught off guard by Trump’s rapid shift to focus on health care last week, said the White House would need to make the first move by putting forward its own proposal.

    Early April Fools’ joke?

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  14. Stormy Dragon says:

    Every single plan that this White House has ever put forward since Donald Trump was elected, covered pre-existing conditions.

    I suppose this is technically true since the White House hasn’t put forward any plans since Donald Trump was elected.

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  15. al Ameda says:

    I watched MTP and listened to Sen. John Barasso (R-WY) flat out out dissemble concerning Republican plans to improve health care.

    SEN. JOHN BARRASSO: You know, the Obama healthcare law, I think Republicans and Democrats agree, it has failed to keep its promises. Prices are skyrocketing and continue — I was in Wyoming, at my medical office on Friday, talking to patients, doctors. Bronze plan, cheapest bronze plan, in Wyoming, for a family of four, $1,900. The deductible, $12,000. That’s not right. The president is right. This is on the American people’s minds.

    Strip away the bullsh** – Republicans have spent about 8 years doing their best to ensure that Obamacare does not work – and it (the Republican plan) is very simple – repeal ACA.

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  16. Kit says:

    If the shade of Marie Antoinette is looking on, she must be thinking that she was born at the wrong time. Today, she could tell the hungry Republican proles to eat cake, and then bask in their adoration.

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  17. Kylopod says:

    I think Trump is making a serious miscalculation in thinking he can get a political boost from this issue. Health care was one of the big issues that drove Democratic gains in 2018. It’s not something that excites his cultists–at least not to anywhere near the degree of, say, “build the wall”–it probably turns off his soft supporters, it’s devastating to swing voters, and it only inspires greater Democratic turnout. I don’t think the legal challenge will ultimately be successful (it would require John Roberts to do an inexplicable about-face), but if it is, it’ll be throwing a hand grenade into the populace at a time when Trump’s political survival is absolutely dependent on the economy, and it will only bolster Democratic calls for Medicare-for-all.

    Health care worked in the GOP’s favor during the Obama years because it gave them a powerful line of attack against a Democratic administration. Whatever problems there were in the health-care system could simply be blamed on the sitting president whose very name was identified with the law. Once Trump took over and proceeded to make changes to the law and even to claim he had already repealed Obamacare, it became very hard for him to convince most voters to blame Democrats for the problems. He may think he can do it now that Dems control the House, but it never worked that way for Obama after the 2010 GOP takeover of the House. It’s always the White House that is going to be seen as the engine of the status quo. That’s probably the main reason why the ACA only started to become popular after Trump became president.

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  18. Just nutha ignint cracker says:

    “The White House GOP clearly doesn’t have has never had a plan beyond attacking Obamacare to score political points.

    FTFY. And why are you surprised about it? (Now I can go back and read the article.)

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  19. Slugger says:

    Anybody remember the last Republican healthcare law? The Medicare Modernization Act of 2003 provided for some prescription benefits for Medicare recipients. It also contained the “donut” hole for those benefits which was improved by the ACA. The worst part was that it forbade the government from negotiating drug prices which means we pay list price. I am sure a savvy dealer maker will do away with this.

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  20. Scott F. says:

    I ask this sincerely as I’ve been racking my brains trying to come up with an example.

    Can anyone think of the last Republican policy that wasn’t fundamentally “smoke and mirrors”? That is a policy that accomplished what was publicly promised without hiding the consequences/costs or where the mechanism of action in the policy made sense on the logic.

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  21. Sleeping Dog says:

    This is not news to anyone who reads this blog, but it’s worth repeating. Obamacare is a Repug policy, conceived by Heritage, proto-typed by Gov Mitt Romney and perhaps the greatest Repub policy initiative in 40 years. Perhaps the way out of this box is for the House produce and pass legislation that fixes Obmacare’s deficiencies, call it Trumpcare and let him crow that he is the president of healthcare.

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  22. MarkedMan says:

    @gVOR08:

    You have to see the base’s belief as religious, not rational

    For years I was puzzled by certain people’s attraction to the phoniest of the phony. Think Tammy Faye and Jim Baker. It seemed to me that there were any number of alternatives to these obvious comment that said basically the same thing but were much more believable. How could people be taken in by these shysters?

    My revelation came when I realized that the typical (not all, but many) Evangelical worships not God but instead Faith. There is nothing more important to them then demonstrating their faithfulness despite all evidence. And of course it is not limited to the religious. There are any number of obvious phonies in all kinds of professions that seem to engender this. The leaders of multi-level marketing schemes come to mind. And of course the Republican Party has become a stinking cesspool full of people who blindly accept that tax cuts for the rich increase revenue, that Trump is not a traitorous swine, that Sean Hannity is sincere.

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  23. Michael Reynolds says:

    @Sleeping Dog:
    Yes, but it was accomplished by a black president. Black presidents don’t count and all they’ve done must be erased. Only by obliterating all trace of the black president can the white supremacist in the White House feel important.

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  24. Mister Bluster says:

    After all, they controlled Congress for two years, and where was the big ACA fix?

    No they didn’t. Just ask Senator Ron Johnson R-WI.
    GOP senator says Republicans didn’t control Senate when they held majority.
    “We needed Democrats, we never had any cooperation from Democrats,..”

    I think Sen. Johnson is whining. But what do I know?

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  25. Kylopod says:

    @Sleeping Dog:

    Perhaps the way out of this box is for the House produce and pass legislation that fixes Obmacare’s deficiencies, call it Trumpcare and let him crow that he is the president of healthcare.

    I’ve been hearing that kind of theory going all the way back to 2012 (applied to Romney). The problem, as I see it, is that I don’t think the GOP ever supported this type of plan in good faith (at least, not since President Nixon). In 1993 they did it as a foil for the Clinton plan. They never tried to pursue it when they actually got into power. Governor Romney did it only because he was presiding over a blue state with a Democratic legislature, working together with Ted Kennedy to bolster his cred as a New England moderate. The current GOP has neither the interest nor incentive to increase the public’s access to health care. Their single interest is to further enrich the rich on the backs of the poor as much as they think they can get away with it.

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  26. Sleeping Dog says:

    @Michael Reynolds:
    @Kylopod:

    Don’t have a disagreement with either of you, but it would be fun, in a trolling sort of way, to see repugs tie themselves in knots voting against trumpcare.

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  27. Kathy says:

    @Sleeping Dog:

    Remember Kathy’s First and Most Important Rule of Politics: It’s wrong only when the other party does it.

    The Second Rule is: It’s right only when our party proposes it.

    Meaning that if Party A takes a plan made by Party B and implements it, it’s ipso facto wrong because it wasn’t Party B that proposed it as legislation.

    If after El Cheeto leaves office never having erected his vanity wall, the victorious Democratic president suggests building a wall, the GOP will cry bloody murder, tear their garments, smear themselves in dung and mud, and roll around in ashes, proclaiming how evil and immoral this latest insane Democratic policy is.

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  28. Scott says:

    After all, they controlled Congress for two years, and where was the big ACA fix?

    It is worse than that. They’ve had nine years to come up with an alternate plan. Not only Congress, but the Republican Party, the conservative think tanks, anyone. There is nothing.

    Think about it. The only alternatives are coming from the left: Medicare for All, expanded Medicare, all kinds of universal healthcare scheme.

    Think about what that means for the arguments. ACA is now the baseline system. It can only go left.

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  29. gVOR08 says:

    @Sleeping Dog:

    Obamacare is a Repug policy, conceived by Heritage, proto-typed by Gov Mitt Romney and perhaps the greatest Repub policy initiative in 40 years.

    Romney winning the Republican nomination while everyone allowed him to push his role in Obamacare down the memory hole was one of the weirdest things I’ve seen in politics.

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  30. Kathy says:

    @Scott:

    It is worse than that.

    Keep digging. You’ve yet to reach the bottom.

    They also had the first six years during Bush the younger’s term to come up with a healthcare plan, and all they came up with was an add-on for Medicare (and a doughnut hole).

    But wait, there’s less!

    They also had the last six years of Clinton’s term to come up with a healthcare plan, and all they could come up with was a government shutdown.

    Healthcare legislation is proving to be as intractable as immigration legislation. no one can do squat, save they who score a filibuster-proof majority in the Senate.

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  31. Just nutha ignint cracker says:

    @Scott: Worse than that, they argued that they needed Trump elected so that they could enact the better healthcare proposal that they had been claiming to have since the middle of the battle to pass the ACA.

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  32. An Interested Party says:

    Strip away the bullsh** – Republicans have spent about 8 years doing their best to ensure that Obamacare does not work – and it (the Republican plan) is very simple – repeal ACA.

    The Republican MO for the past few decades…get in government, screw it up, than say how bad government is…no wonder Trump got in on this scam…

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  33. Kylopod says:

    @gVOR08:

    Romney winning the Republican nomination while everyone allowed him to push his role in Obamacare down the memory hole was one of the weirdest things I’ve seen in politics.

    Jonathan Chait is one of my very favorite political commentators, but he really stepped in it during the 2012 GOP primary cycle. Starting in 2010 he ran a series of pieces he called “Romney Death Watch,” in which he repeatedly mocked the idea that Romney could possibly win the GOP nomination. He felt there was no way the GOP in the Tea Party era were going to nominate the architect of proto-Obamacare. He was fairly stunned when it finally happened, and he felt Romney had lucked into getting so many self-immolating opponents.

    But I don’t think it was luck, and I don’t think it was that weird, either. One of the things Romney had going for him was that he had the establishment lane all to himself, with Tim Pawlenty and Jon Huntsman far too weak to provide a credible challenge. The only one who ever really had a shot but ended up self-immolating was Rick Perry, who was essentially sucked into the race under pressure from conservatives desperate for a credible non-Romney.

    The problem all the non-Romneys kept running into was that there were several of them, but only one Romney. Therefore, the votes of Republicans who wanted an alternative to Romney were fractured, whereas the GOP establishment who just wanted a safe choice were unified. It was later reported that Gingrich and Santorum privately met to discuss the possibility of teaming up to take on Romney–but it fell through because they couldn’t agree on who’d be top dog.

    In 2016, the dynamic was reversed. Though deeply opposed by the party establishment, Trump effectively acquired the advantages Romney had possessed: even though there was strong resistance to him, nobody could unify around an alternative. I’ve mentioned it many times before, and I’ll mention it again: a poll taken in Feb. 2016 found that when Republican voters were asked to choose between Trump and Rubio in a two-person race, Rubio beat Trump by double digits.

    This is why I think a lot of the grand theories people come up with to explain the outcome of primaries are flawed: primaries are a very haphazard process that don’t necessarily come down to voters speaking in a single voice. A lot can turn on very technical matters including how many candidates there are, the exact schedule of each primary, which are caucuses and which are actual primaries, whether the delegates are allocated proportionally or winner-take-all, and more. Romney may not have fit the mood of the 2012 GOP electorate but he had all the technical and institutional advantages on his side. In the 2016 cycle, the chaotic many-candidate field prevented any of the establishment candidates from acquiring those advantages, which enabled a celebrity outsider with a cult following to win despite never getting a majority of the vote. The outcome in both cases isn’t weird once you understand how complicated the process was.

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  34. Philip H says:

    I remain mildly amused at the perplexity over Republicans inability to come up with something “better.” The major tenants of the ACA – including the often Republican ballyhooed individual mandate – were Republican ideas large codified by the Heritage Foundation in opposition to Hillary Clinton’s work on universal healthcare when Bill was in the White House. If you support market capitalism orthodoxy, the fully enabled ACA is the best you can hope for.

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  35. An Interested Party says:

    C’mon everybody…you are being far too harsh on the GOP…Republicans do actually have a health care plan…I guess you never heard of the Go to The Emergency Room or Stay Home and Die Act…

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