FacebookTwitterGoogle+RedditEmail

Trump’s Plot to Kill Obamacare

by

After a Republican push to revamp health care came up short of Senate support earlier this month, President Donald Trump announced his new health care strategy. He was going to “let Obamacare fail” and then give us all really great health care.

The second part of this claim is, of course, absurd. The health care Republicans are proposing would be a disaster for tens of millions of people. This is the reason Trump and Republican congressional leadership are having such a hard time getting adequate support.

But the first part of Trump’s strategy is also clearly wrong. Obamacare is not failing; if it collapses, it will be because Trump and his Republican allies killed it.

The claim that Obamacare is failing rests largely on the number of insurers that have left the health care exchanges set up under Obamacare. Trump and the Republicans are continually pointing out that more than 1,300 counties only have a single insurer operating in their exchanges, meaning that there is no competition.

While Trump is predicting the situation will continue to deteriorate, with more counties with one or no insurer left in the exchanges, the experts who study the issue actually find the opposite.

The assessment of the Congressional Budget Office, the Kaiser Family Foundation and others is that the health care exchanges have largely stabilized and insurers are now able to operate profitably.

Contrary to the stories of a death spiral, the number of people getting insurance through the exchanges is actually increasing.

It is also important to realize that the lack of competition in the exchanges is primarily a problem for people who live in states controlled by Republicans.

More than 20 percent of the people who live in states with Republican governors only have one insurer in their exchange. Only 2 percent of the people who live in states with Democratic governors live in a county with a single insurer. This figure excludes North Carolina, where a Democratic governor just took over in January.

This gap is due to the fact that most Republican governors did not want Obamacare to succeed, while most Democrats did.

First and foremost, many Republican governors did not expand Medicaid. This expansion helped the exchanges by pulling out many of the less-healthy people from the patient pools in the exchange.

These governors also were not aggressive in promoting the exchanges. As a result, fewer healthy people signed up for insurance, making the exchange population less healthy than in states controlled by Democrats trying to make the ACA work.

In the story of Obamacare dying, Trump apparently plans to build on the success of Republican governors and undermine the exchanges in the states controlled by Democrats. And, he does have tools to do it.

The first tool is the reimbursements the government makes to insurers for covering out-of-pocket costs for low-income people. If insurers did not cover these expenses, insurance would be unaffordable for many low-income people. And, the insurers won’t cover the costs if the government is not picking up the tab.

More importantly, Trump could refuse to enforce the individual mandate. This is an essential part of the system, since insurers are prohibited from discriminating against people based on their health. Without the mandate, many healthy people will opt not to buy insurance until they develop a serious health problem.

This is a sure path to a death spiral. In this scenario, insurers raise rates because of their less healthy pool. The higher rates discourage more healthy people from getting insurance, further worsening the health of the average insure. This cycle continues until the pool only includes the least healthy and most expensive patients.

Through these and other mechanisms, President Trump certainly can kill Obamacare. But this is not letting the program die.

This column originally appeared in the Sacramento Bee.

More articles by:

Dean Baker is a macroeconomist and co-director of the Center for Economic and Policy Research in Washington, DC. He previously worked as a senior economist at the Economic Policy Institute and an assistant professor at Bucknell University.

February 21, 2018
Cecil Bothwell
Billy Graham and the Gospel of Fear
Ajamu Baraka
Venezuela: Revenge of the Mad-Dog Empire
Edward Hunt
Treating North Korea Rough
Binoy Kampmark
Meddling for Empire: the CIA Comes Clean
Ron Jacobs
Stamping Out Hunger
Ammar Kourany – Martha Myers
So, You Think You Are My Partner? International NGOs and National NGOs, Costs of Asymmetrical Relationships
Michael Welton
1980s: From Star Wars to the End of the Cold War
Judith Deutsch
Finkelstein on Gaza: Who or What Has a Right to Exist? 
Kevin Zeese - Margaret Flowers
War Preparations on Venezuela as Election Nears
Wilfred Burchett
Vietnam Will Win: Military Realities
Steve Early
Refinery Safety Campaign Frays Blue-Green Alliance
Ali Mohsin
Muslims Face Increasing Discrimination, State Surveillance Under Trump
Julian Vigo
UK Mass Digital Surveillance Regime Ruled Illegal
Peter Crowley
Revisiting ‘Make America Great Again’
Andrew Stewart
Black Panther: Afrofuturism Gets a Superb Film, Marvel Grows Up and I Don’t Know How to Review It
CounterPunch News Service
A Call to Celebrate 2018 as the Year of William Edward Burghardt Du Bois by the Saturday Free School
February 20, 2018
Nick Pemberton
The Gun Violence the Media Shows Us and the State Violence They Don’t
John Eskow
Sympathy for the Drivel: On the Vocabulary of President Nitwit
John Steppling
Trump, Putin, and Nikolas Cruz Walk Into a Bar…
John W. Whitehead
America’s Cult of Violence Turns Deadly
Ishmael Reed
Charles F. Harris: He Popularized Black History
Will Podmore
Paying the Price: the TUC and Brexit
George Burchett
Plumpes Denken: Crude thinking
Binoy Kampmark
The Caring Profession: Peacekeeping, Blue Helmets and Sexual Abuse
Lawrence Wittner
The Trump Administration’s War on Workers
David Swanson
The Question of Sanctions: South Africa and Palestine
Walter Clemens
Murderers in High Places
Dean Baker
How Does the Washington Post Know that Trump’s Plan Really “Aims” to Pump $1.5 Trillion Into Infrastructure Projects?
February 19, 2018
Rob Urie
Mueller, Russia and Oil Politics
Richard Moser
Mueller the Politician
Robert Hunziker
There Is No Time Left
Nino Pagliccia
Venezuela Decides to Hold Presidential Elections, the Opposition Chooses to Boycott Democracy
Daniel Warner
Parkland Florida: Revisiting Michael Fields
Sheldon Richman
‘Peace Through Strength’ is a Racket
Wilfred Burchett
Vietnam Will Win: Taking on the Pentagon
Patrick Cockburn
People Care More About the OXFAM Scandal Than the Cholera Epidemic
Ted Rall
On Gun Violence and Control, a Political Gordian Knot
Binoy Kampmark
Making Mugs of Voters: Mueller’s Russia Indictments
Dave Lindorff
Mass Killers Abetted by Nutjobs
Myles Hoenig
A Response to David Axelrod
Colin Todhunter
The Royal Society and the GMO-Agrochemical Sector
Cesar Chelala
A Student’s Message to Politicians about the Florida Massacre
Weekend Edition
February 16, 2018
Friday - Sunday
Jeffrey St. Clair
American Carnage
Paul Street
Michael Wolff, Class Rule, and the Madness of King Don
Andrew Levine
Had Hillary Won: What Now?
FacebookTwitterGoogle+RedditEmail