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Opinion: What If Trump-Care Works in CA? What If It Doesn’t?

By Tom Elias

One problem in having a President who operates without much regard for facts, truth or consistency – one whose staff has devised the concept of “alternative facts” – is that when he says or promises something, no one can know whether he means it.

So it was with President Trump’s mid-January promise of “health insurance for everybody,” including better coverage, more choice among policies, lower deductibles and no one left behind – far different from anything his Republican allies in Congress ever promised in their many efforts to “repeal and replace” Obamacare, the Affordable Care Act (ACA.)

Trump later “walked back” this commitment, promising now only that “There will be nobody dying on the streets in a Trump administration.” Then, in his first executive order, he authorized officials to disregard or delay parts of the ACA, including the unpopular mandate that most Americans must buy insurance or pay a tax.

For now, details of what some are calling “Trump-care” remain a mystery. But there’s plenty of information available on what Obamacare has meant in California. Here are some facts: The number of previously-uninsured Californians covered under Medi-Cal (the state’s version of federal Medicaid) and the Covered California program of group and individual policies jumped this winter above 5 million – most of whom had no coverage before Obamacare.

Premiums have risen for them, but so have federally-funded subsidies to help many cover those costs – unless Trump and his allies undo the subsidies.

U.S. Sen. Dianne Feinstein says more than 3.7 million low-income California adults would lose health coverage if the ACA were repealed, as Republicans in Congress voted tentatively to do the other day.

Another 1.2 million here would lose the tax breaks they now use to buy insurance through Covered California.

But Republicans in Congress, led by House Speaker Paul Ryan of Wisconsin, insist they won’t merely repeal what exists now; they’ll replace it with something better. Most versions they have floated of that “improvement” would include higher deductibles and lower coverage at greater cost, but the GOP says customers would then comparison shop and see market competition drive prices down.

Now comes Trump, at first promising something no other Republican ever touted: In a telephone interview with the Washington Post, he promised universal coverage, which Democrats sought for decades but never achieved. He also vowed to force drug companies to negotiate prices directly with both Medicare and Medicaid, possibly lowering prices for seniors on Medicare Part D and for some others.

Said Trump, “There was a philosophy…that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Rather, he said, everyone in America “can expect to have great health care….Much less expensive and much better.”

We already know that if Obamacare were simply abandoned, left moldering beside history’s highway with no replacement, at least some deaths and disabilities would follow. Cancer patients who could previously get no care once again would get little or none. Immunizations would drop drastically. Treatment for everything from kidney stones to the common cold would be cut, with commensurately more epidemics.

All this could happen if Trump’s still secret new plan for health care doesn’t work and amounts in real life to a simple repeal of Obamacare. Obama claimed in one of his many exit interviews that the ACA has established that mass insurance can be done; Trump’s mixed messages leave it unclear whether he buys this idea.

And what if Trump-care actually appears and it works? The first reality is that this would likely see Trump and his fellow Republicans reelected easily both in 2020 and in the mid-term year of 2018.

A second is that if health care becomes available to all at lower prices than today’s, California and America will be healthier places.

But there is no assurance anything remotely like this will happen, or that it will work if it is mandated. In fact, Trump backtracked at least twice on what he said about universal access to health care. The devil is always in the details, of course, and that’s especially true with any Trump proposal, if only because he so often plays fast and loose with both facts and his own past statements.

in Opinion
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