March 06, 2016
There may finally be one thing Republicans hate more than ObamaCare: TrumpCare.
The GOP front-runner, after weeks of talking in vague terms about his plans for the health care system, put out a seven-point proposal Wednesday night, just in time for the GOP debate in Detroit and four more primary contests this weekend.
But within hours, Republican opinion leaders in health care were already piling on.
“It has the look and feel of something that a 22-year-old congressional staffer would write for a backbencher based on a cursory review of Wikipedia,” wrote Avik Roy, the opinion editor at Forbes who has advised several GOP presidential candidates on health policy, including Mitt Romney in 2012.
“Think of it as a college student finding out the exam is tomorrow, and he has to study for it the night before,” said Thomas Miller of the American Enterprise Institute, one of the health policy advisers to GOP nominee John McCain in 2008.
But perhaps the sharpest invective against the plan came from one of the most strident opponents of the Affordable Care Act: Michael Cannon of the libertarian Cato Institute.
“Trump’s actual health care plan is a series of ignorant, incoherent, and self-contradictory verbal spasms,” Cannon wrote on Forbes’ website. “He doesn’t have a plan. He has paroxysms.”
While many leaders in the Republican Party in general are in the midst of a “stop Trump” campaign, these health policy experts have very specific reasons for being so down on the health proposal.
One is that in several cases what Trump is proposing is already available.
For example, one of the points of the plan is to “allow individuals to use Health Savings Accounts (HSAs),” with tax-free treatments of both contributions and growth. HSAs were originally authorized as part of the 2003 Medicare prescription drug law.
“On HSAs, he’s discovered 12 years later what current law is,” said Miller. “It is not quite as bold as the Columbus discovery of the New World, but similarly lacking in navigational familiarity.”
The GOP analysts also complain that Trump’s plan is at odds with some of the things he’s said on the campaign trail.
Cannon noted that Trump said at the CNN-Telemundo debate last month that “except pre-existing conditions, I would absolutely get rid of Obamacare.” But in his actual plan, Cannon wrote, Trump “says he would repeal Obamacare ‘completely,’ without any mention of retaining those provisions, or any mention of how he would otherwise cover people with pre-existing conditions.”
Trump has also claimed on the campaign trail (although not in his formal plan) that the nation could save as much as $300 billion by allowing the Medicare program to negotiate prescription drug prices.
Cannon noted that “is actually more than twice what state and federal governments spend on drugs combined [mostly for Medicare and Medicaid]. Apparently, drug manufacturers are going to pay us to take their drugs.”
Fox News moderator Chris Wallace pressed Trump on that point in the Detroit debate, pointing out that Medicare spends only about $78 billion on prescription medications.
Trump responded that “I’m not only talking about drugs, I’m talking about other things. We will save $300 billion a year if we properly negotiate.” His campaign did not respond Friday to an email about the criticisms of the plan.
Related story: Does Trump have a health care plan? Does it matter?
Finally, some aspects of the plan simply defy GOP orthodoxy when it comes to health policy.
For example, wrote Roy, Trump would permit everyone to deduct health insurance premiums from their taxes. (Currently those who are self-employed can do that, as can businesses, and those who get employer-provided insurance do not pay taxes on the value of that coverage.)
“The principal reason why health care is so expensive in America is that we heavily subsidize its consumption through the tax code,” Roy wrote.
But at least one of the analysts said it represents progress that Trump even has a plan. “When the slower students begin to show signs of improvement you want to encourage them,” said Miller.
This story was produced by Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.