President Trump has a problem: The Congressional Budget Office, led by a Republican appointee, keeps reporting that Republican health care bills are worse than Obamacare. In March, CBO projected that the House GOP bill would leave 24 million more people uninsured than under current law. On Monday, CBO projected that the Senate GOP bill would increase the uninsured population by 22 million. For people who remain insured, CBO says both bills would increase combined premium and out-of-pocket medical costs.
How can Trump campaign for bills that are worse than Obamacare? By claiming that Obamacare no longer exists. You can’t compare Trumpcare to Obamacare, he says, because Obamacare is gone. So be grateful for whatever Republicans offer you.
Trump has predicted Obamacare’s death for months. He has pronounced it “dying, dying, dying,” “in a death spiral,” “on its last legs,” “on its last, dying feet,” “on a respirator,” “dead,” and “gone.” This terminal prognosis is bogus, in part because, as Jonathan Chait has noted, one of the trends Trump complains about—insurers raising premiums—counteracts the other trend: financial losses that were driving insurers out of the program’s individual markets.
Trump doesn’t care about this fallacy, because his goal is political: to eliminate pesky comparisons between Obamacare and the GOP’s inferior substitutes regardless of the truth. His biggest problem is CBO, whose job is to contrast the projected consequences of proposed legislation with the projected consequences of current law.
On March 13, CBO issued its damning assessment of the House bill. In response, the White House dismissed the whole idea of juxtaposing the House bill with Obamacare. “This idea of comparing it to Obamacare is a false choice,” White House Press Secretary Sean Spicer told reporters because, due to Obamacare’s impending demise, “The choice is going away.” The next day, at a rally in Nashville, Tennessee, Trump declared: “There’s nothing to compare anything to because Obamacare won’t be around for a year or two. It’s gone.” At an April rally in Harrisburg, Pennsylvania, Trump repeated: “They always like to compare, ‘Well, what about Obama?’ Obamacare is dead. It’s gone.” At a press conference in May, Trump insisted, “Obamacare is collapsing. It’s dead. It’s gone. There’s nothing to compare anything to because we don’t have health care in this country.”
Trump isn’t just forecasting imminent demise. He’s doing what he can to speed it along, scaring insurers out of the market and driving up premiums by threatening not just to kill the program in Congress but to unilaterally yank the subsidies on which insurers and policyholders depend. At the White House on Wednesday, Trump issued another threat: “Obamacare is dying. It’s essentially dead. If you don’t give it the subsidy, it would die within 24 hours.”
In the last two weeks, as Republicans braced for a bad CBO score on the Senate bill, they escalated the Obamacare death watch. Since June 19, Trump has tweeted three times that “Obamacare is dead.” At a June 21 rally in Iowa, he scoffed, “Obamacare is a disaster. It’s over. And there’s nothing to compare [to] what we’re doing.” On Monday, as CBO issued its assessment of the Senate bill, Spicer lectured reporters: “We need to accept that Obamacare is dead.” On Tuesday, at a Capitol press conference, Republican senators said the program was “collapsing” and “going off a cliff.” On Wednesday, Trump reminded everyone that Obamacare would die if he pulled the plug.
Trump’s campaign to declare Obamacare dead, and possibly kill it himself through executive action, is grotesque. In the context of caring for sick people, it’s morbidly ironic, particularly coming from the party that shrieked about “death panels.” It’s also a betrayal of Republican principle. Conservative health insurance reform was supposed to be about better care through competition. Trump isn’t trying to beat the competition. He’s trying to erase it.