So much for President Trump’s pledge of “insurance for everybody.”
The Congressional Budget Office said on Monday that next year 14 million fewer Americans will have insurance if the Affordable Care Act, or Obamacare, is repealed and replaced on the terms the president is seeking. That tally would rise to 21 million in 2020 and 24 million in 2026. By then, the total number of uninsured Americans would reach 52 million.
And for what? To give a gigantic tax cut to wealthy Americans.
According to the C.B.O. the loss of health care coverage under the Republican plan stems largely from gutting Medicaid for low-income Americans, even though Mr. Trump has said he would not cut Medicaid. Coverage would also be lost in part because insurance would become unaffordable for millions as subsidies are withdrawn, despite Mr. Trump’s claim that coverage would become “much less expensive and much better.”
Older people would be hard hit. The Republican plan repeals the penalty for not buying insurance. One predictable result of this change is that premiums will rise as younger, healthier people refuse to buy insurance. To hold down the cost of average premiums, the proposal would allow insurers to charge five times more for older enrollees than younger ones, rather than three times, as permitted under Obamacare. The outcome would be reduced premiums for young adults, essentially paid for by charging substantially higher premiums for older people — and higher deductibles and other cost-sharing for everyone.
At the same time, the plan provides a $600 billion tax cut over 10 years for wealthy Americans, because they would no longer be subject to the taxes that pay for the health care subsidies. When the tax cuts for the rich and the spending cuts to Medicaid are combined, they would result in deficit reduction of $337 billion by 2026. That’s a small fraction of the national debt in exchange for an enormous amount of human misery.
Trump administration officials and congressional Republicans knew the C.B.O. report would be devastating, so last week they launched a pre-emptive attack on the agency, disparaging its professionalism and findings. Their insults were an impressive display of staying on message for an administration and party that has descended into infighting over the elements of the repeal plan. This might have been expected. Yet in the past President Trump himself has tweeted C.B.O. findings to attack President Obama on economic growth, tax cuts, employment and other issues.
“We disagree strenuously with the report that was put out,” Health and Human Services Secretary Tom Price said on Monday. “It’s just not believable.”
Well, whether Mr. Price wants to believe it or not, the numbers are the numbers. The C.B.O. has called it as it sees it, and the picture is clear: Trumpcare would throw millions of Americans off their health coverage. And no amount of spin or scorn for the C.B.O. can alter that reality.