The evasive, cynical Republican defense of Trumpcare.

How Can Republicans Defend the Atrocity That Is Trumpcare? Like This.

How Can Republicans Defend the Atrocity That Is Trumpcare? Like This.

Who's winning, who's losing, and why.
May 8 2017 3:07 PM

The GOP Game Plan for Defending Trumpcare

It’s evasive, it’s irrational, it’s pretty damn slick. 

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Paul Ryan, Reince Priebus, and Tom Price.

Chip Somodevilla, Alex Wong, Alex Wong/Getty Images

The health insurance bill passed by House Republicans on Thursday is a gut punch to the working people who elected President Trump. It whacks Medicaid, cuts insurance subsidies, and raises premiums and out-of-pocket costs to fund a tax cut for the rich. How do Republicans defend this atrocity? With aplomb. Four Trump surrogates—White House Chief of Staff Reince Priebus, Budget Director Mick Mulvaney, Health and Human Services Secretary Tom Price, and House Speaker Paul Ryan—fanned out on the Sunday shows to answer criticisms of the bill. Here’s what they said.

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

1. It’s better than nothing, and Obamacare is nothing. At his rally in Harrisburg, Pennsylvania, a week ago, Trump jeered that Democrats and the media “always like to compare” Trumpcare to Obamacare, but they can’t, because “Obamacare is dead. It’s gone. … So they can’t compare something to it, because it won’t be there very long, believe me.” That’s the main pitch from Trump’s minions: Obamacare is finished, so you’ll have to settle for whatever we offer.

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On the Sunday shows, Trump’s surrogates gave this answer to every complaint about Trumpcare. On Fox News Sunday, Priebus called the debate “a binary choice between what we know is a collapsing system, offering no options, no coverage,” and a GOP alternative “that offers coverage.” On Face the Nation, John Dickerson asked Mulvaney: “If I get health care through Obamacare, what kind of promises does this House bill make to me?” Mulvaney replied: “That it will actually be there.” On This Week, Ryan posed as a savior of Obamacare refugees. “Obamacare is collapsing, he declared. “We’re stepping in front of it and rescuing people from a collapsing system.”

This is worse than fraud. It’s sabotage. Trump, Ryan, and their allies are trying to kill off Obamacare by scaring insurers out of the market. Their goal in doing this is to make people so miserable and afraid that they’ll accept bad coverage.

2. Everyone will come out ahead. Price, appearing on Meet the Press and State of the Union, said Trumpcare would reduce premiums and deductibles for young people by freeing them from having to subsidize insurance for older people. Yet he insisted that older folks, too, would somehow pay less and get more. This would happen through the magic of “competition,” he suggested, glossing over the fact that competition in the insurance market is principally about attracting healthy people and excluding sick ones. Ryan, meanwhile, claimed that states, through other magical innovations, would lower costs and improve care for everyone. Neither Price nor Ryan could explain the mechanics of these math-defying breakthroughs.

3. Don’t believe data that say the bill is bad. When journalists investigate and expose Trump’s lies, he calls their reports “fake news.” Republicans apply the same brushoff to the Congressional Budget Office. Mulvaney says you can’t trust the CBO’s earlier analysis that Trumpcare would cut the number of insured people by 24 million, because CBO “missed the mark” in projecting Obamacare enrollment. He neglects to mention that CBO overestimated coverage under Obamacare and that Republicans are trying to snooker you into thinking that the same analysts are wildly underestimating coverage under Trumpcare.

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What’s really going on here is a cynical attack on metrics. Republicans like to point out, for example, that “coverage” doesn’t guarantee “care.” That’s true, but they use this point, illogically, to argue that reductions in coverage don’t matter. Price says CBO’s estimate of Medicaid cuts under Trumpcare—$880 billion over 10 years—applies to coverage but not care. Mulvaney gives the same answer when asked about Trump’s promises to cover everyone: What matters is care, not coverage. These are all obfuscations of the bottom line: When you lose coverage, you lose care.

4. If you lose coverage, that’s your choice. Ryan says, falsely, that the 24 million people who would lose coverage under Trumpcare, according to CBO, are all young people who “don’t want to buy” insurance. It’s “their own free choice,” he asserts. Likewise, he claims “you cannot be denied coverage if you have a preexisting condition” under Trumpcare—which is technically true, because the coverage would not be unavailable, just unaffordable. Price adds that people with preexisting conditions will theoretically be “able to see the doctor that they want to see” and get “the kind of coverage that they want.” These are all variations on the libertarian theme that freedom consists of the political right to buy things even when you can’t afford them. Republicans simply don’t think it’s their job to make anything, including health care, affordable to everyone.

5. Medicaid is welfare. Price says Medicaid goes to “the disabled, the elderly, healthy moms, and kids.” While Trumpcare cuts back Medicaid spending, he argues, it allows “more resources” for the old and disabled, and “appropriate resources” for the moms and kids. In other words, to protect the old folks, the moms and kids get squeezed. Ryan, euphemistically, makes the same point. Mathematically, it doesn’t add up: Two-thirds of people on Medicaid are elderly or disabled, so they can’t all be shielded from the bill’s 25 percent cut in the projected Medicaid budget.* But the bigger story here is the suggestion by Republicans—made explicit by GOP strategist Karl Rove—that anyone who loses coverage under their Medicaid cuts is lazy and undeserving.

6. The bill is whatever we say it is. When reporters point out that the GOP rammed through its revised bill without getting the requisite cost and coverage analysis from CBO, Ryan says the revised bill is virtually identical to the original bill, which CBO analyzed. But when reporters point out that CBO said the original bill would reduce the insured population by 24 million, Priebus says the estimate is obsolete, because “that’s the old bill. That’s before the amendments were put in. And it’s also before the Senate takes the bill and makes it even better.”

By shuffling between past, present, and future versions of the bill, Republicans shield it from scrutiny. Ryan says it will improve in wonderful ways. “We’re going to add more money to the tax credit for … people who are 50 and 60 years old,” he promises. There will also be “more support for people with preexisting conditions.” Mulvaney says critiques of the version passed by the House are irrelevant: “We are all sort of guessing right now, because the negotiation is ongoing.” And by delegating hard choices to the states, Republicans duck accountability for any resulting cuts. For example, the bill invites states to apply for waivers that allow higher premiums for people with preexisting conditions. But Priebus won’t own the waiver system, asserting: “I’m not sure that’s ever going to happen.”

That’s the game plan for defending Trumpcare: Sabotage the current health insurance market, discredit metrics, fudge the math, denigrate Medicaid, duck responsibility, and keep the bill in flux so nobody can pin it down. It’s a cynical campaign. But to be fair, it’s no more cynical than the bill itself.

*Correction, May 9, 2017: The article originally misidentified a proposed 25 percent cut in the projected Medicare budget. The proposed cut is in the Medicaid budget. (Return.)

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