President Trump spent much of the weekend talking about health care. On Saturday, he sat down with Face the Nation host John Dickerson and spoke about the GOP health-care plan in some detail. In the interview, he seemed to guarantee that the bill would protect people with pre-existing conditions. The American Medical Association and outside health policy analysts mostly disagree with this assertion.
While House Republicans were apparently short of votes for their newly revised American Health Care Act on Friday, GOP vote-counters now believe they will have enough votes to pass the bill this week, as early as Wednesday. Rep. Chris Collins (R-N.Y.), a key Trump ally in Congress, tells The New York Times that House Republicans won't seek a new Congressional Budget Office analysis of the bill before they vote; the last CBO score found that the AHCA would lead to 24 million fewer insured Americans in 10 years. Here, an annotated look at Trump's comments on health care over the weekend:
- "We're going to get the premiums down, we're going to get the deductibles way down, we're going to take care of every single need you're going to want to have taken care of, but it's not going to cost that kind of money." [Trump rally, Pennsylvania]
There's no such thing as a free lunch, says David Nather at Axios. "Health insurance is a series of tradeoffs — you can have lower premiums or lower deductibles, but usually not both. And if they are both lower, it's usually because the plan covers fewer benefits."
- "Pre-existing conditions are in the bill. And I just watched another network than yours, and they were saying, 'Pre-existing is not covered.' Pre-existing conditions are in the bill. And I mandate it. I said, 'Has to be.' ..." [Dickerson: "So I'm not hearing you, Mr. President, say there's a guarantee of pre-existing conditions."] "We actually have — we actually have a clause that guarantees. We have a specific clause that guarantees." [Trump, Face the Nation]
The latest amendment, from Rep. Tom MacArthur (R-N.J.) does say that "nothing in this act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with pre-existing conditions," but it also allows the federal government to grant states waivers that would allow insurers to charge different prices based on "health status." That means insurers could charge higher rates for people with cancer, multiple sclerosis, or diabetes, while not blocking access per se. "Although the MacArthur Amendment states that the ban on pre-existing conditions remains intact," the American Medical Association said on Friday, "this assurance may be illusory as health status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions."
- "Pre-existing is going to be in there and we're also going to create pools. And pools are going to take care of the pre-existing." [Trump, Face the Nation]
This may be what Trump means by "covering" people with pre-existing conditions, but it is unclear from his comments. Several states had high-risk pools before the Affordable Care Act, and they tended to be underfunded and unaffordable.
- "The states are also going to have a lot to do with it because we ultimately want to get it back down to the states. Look, because if you hurt your knee, honestly, I'd rather have the federal government focused on North Korea, focused on other things, than your knee, okay? Or than your back, as important as your back is." [Trump, Face the Nation]
Most industrialized nations are able to focus on national defense and diplomacy, while providing health care for residents at the same time.
- "You can't compare anything to ObamaCare because ObamaCare is dead. Dems want billions to go to Insurance Companies to bail out donors. ... New health-care plan is on its way. Will have much lower premiums & deductibles while at the same time taking care of pre-existing conditions!" [Trump, Twitter]
The CBO found that the Affordable Care Act markets would most likely be stable if allowed to continue, though if Trump followed through with his threat to withhold stability funds to insurers — used to subsidize health care for poorer ObamaCare customers — or took other steps to hasten ObamaCare's demise, the markets could collapse.
- "But when I watch some of the news reports, which are so unfair, and they say we don't cover pre-existing conditions, we cover it beautifully. I'll tell you who doesn't cover pre-existing conditions. ObamaCare. You know why? It's dead." [Trump, Face the Nation]
The idea that state high-risk pools would cover pre-existing conditions "beautifully" is up for debate, but it's hard to argue with the logic that a defunct Affordable Care Act would not cover them at all.
- "This bill is much different than it was a little while ago, okay? This bill has evolved. And we didn't have a failure on the bill. You know, it was reported like a failure. Now, the one thing I wouldn't have done again is put a timeline. That's why on the second iteration, I didn't put a timeline." [Trump, Face the Nation]
- "John, this has evolved over a period of three or four weeks. Now, we really have a good bill. I think they could have voted on Friday. I said, 'Just relax. Don't worry about this phony 100 day thing. Just relax. Take it easy. Take your time. Get the good vote and make it perfect.'" [Trump, Face the Nation]
The driving forces behind reviving the GOP health-care bill were widely reported to be Rep. MacArthur, the House Freedom Caucus, and the Trump White House.
- "Most importantly, we're going to drive down premiums. We're going to drive down deductibles because right now, deductibles are so high, you never — unless you're going to die a long, hard death, you never can get to use your health care because the deductibles are so high."
"Deductibles under the Republican plan would not go down," says Sarah Kliff at Vox. "They would go up, according to the non-partisan Congressional Budget Office analysis." And while the CBO predicts that premiums would eventually go down, she adds, "that isn't necessarily great news. Premiums would decline under AHCA because higher premiums for older enrollees would essentially price the elderly out of the individual market. CBO estimated, for example, that a low-income 64-year-old would see her premiums increase 750 percent under AHCA." Also, Trump's "long, hard death" comment seems aimed at people with cancer and other pre-existing conditions.
- "Excuse me, the health-care bill is going to help my supporters. Otherwise, I'm not going to sign it. I'm not going to do it." [Trump, Face the Nation]
Congress wouldn't have the votes to overcome a presidential veto. But "there is no change that House Republicans or the White House have offered publicly that would protect the ObamaCare enrollees that are likely to be Trump voters, generally lower-income and older," says Vox's Kliff. "These are still the people who are most vulnerable to high premiums and fewer consumer protections under the Republican health care plan." Nather at Axios had a similar analysis, but says "the White House pointed me to the changes made in the House manager's amendment, which would make the medical expenses deduction more generous. That's supposed to steer more money toward low-income seniors, but CBO hasn't finished analyzing the changes to make sure they actually help."
- [Dickerson: "Let me ask you about the question of Medicare. They're going to want, in Congress, to make up on the spending side, to change Medicare. Will you allow that?"] "You're not going to have to do it. ... I would much prefer them not to do that, that's right." [Dickerson: "It sounds as if, having covered you in the campaign, it sounds like you're leaving the door open. On the campaign, you were quite clear. You said, 'I'm the guy who's not going to touch Medicare.'"] "Okay, then let me be more clear. I'm not going to touch it, because I said it. Now, waste, fraud, and abuse, I'm going to touch. If there's something in Medicare that's been abused, I will touch that. There are certain things, as you know, that have been absolutely abused. There are certain provisions in Medicare that are horrible and abusive and there's been terrible things happening. So that kind of stuff, I will absolutely touch. But the concept of Medicare, I'm not touching." [Trump, Face the Nation]
It's not clear what he means by "the concept of Medicare," or what Medicare "waste, fraud, and abuse" he's referring to. You can watch his comments on health care below.