In Tuesday’s vice presidential debate, Sen. JD Vance repeated a strange lie about healthcare that Donald Trump made during his debate last month with Kamala Harris. Vance was asked to expound on Trump’s vague claim that he had “concepts of a plan” to replace the Affordable Care Act with something much better that would cover everyone and cost less. Could Vance please say how that would work, and would he “guarantee that Americans with pre-existing conditions won’t pay more?”
Astute Wonkette readers already know that Vance can’t guarantee that, because he says Republicans will return to the bad old days when private health insurance was affordable only if you were young and healthy, while insurers routinely denied coverage for folks who were at higher risk because they might actually need healthcare.
Tim Walz explained that the whole reason the ACA can offer affordable private insurance plans is because 1) individual premiums are subsidized by taxes, and 2) everyone is in the same risk pool, and the premiums paid by young healthies help cover the costs of everyone else. If you segregate by risk, it’s no longer affordable for those who’ll need it, period.
But Vance also flat out lied about what happened during the Trump years, claiming incorrectly that Trump “salvaged Obamacare, which was doing disastrously until Donald Trump came along.” Vance expanded on that lie, saying that
“when Obamacare was crushing under the weight of its own regulatory burden and healthcare costs, Donald Trump could have destroyed the program. Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care.”
None of that is true, as we’ll discuss in some detail because I spent about a third of 2017 following Donald Trump’s failed efforts to kill Obamacare, before he finally said the hell with it and did Big Fat Tax Cuts for Rich Fuckwads instead.
After campaigning on replacing the ACA with a terrific plan that he never got around to announcing, Trump found himself elected, and instead of revealing his big plan that never existed, left it to congressional Republicans to come up with a plan he could say was his all along. The House came up with a terrible “American Health Care Act” that would have rolled back Medicaid expansion and screwed over poor and disabled kids and allow the sale of “junk insurance” that had low premiums but covered very little. You may have noticed no one remembers it, not even the name. Senate Republicans came up with a halfassed “Better Care Act” that, as the name implies, would have been much worse.
Neither passed, and eventually the Senate went ahead with a “skinny repeal” bill that would have repealed many parts of the ACA with no replacement at all and which would have left 16 million Americans with no coverage. But then they’d pass a replacement, you bet! Things never got that far, because John McCain voted Thumbs Down on skinny repeal, joining Lisa Murkowski, Susan Collins, and every last Democrat to leave the ACA in place.
Ah, but Trump wasn’t finished yet, and here’s where Vance’s lie about him “salvaging” the ACA is especially vile, unless it was just a verbal typo and he meant “savaging” it. As the attempts to repeal Obamacare slogged forth, Trump also tried to kill it with executive actions that knocked out parts of what made it work. He chopped weeks off the annual open enrollment period, eliminated advertising to let people know it was available, and eliminated federal “navigators” who helped people select plans, although quite a few blue states ramped up their own outreach efforts to make up for it.
Every day, in every way, Trump tried to chop away federal support and change rules in ways that would make the ACA more cumbersome, but then a funny thing happened. Trump sought to make the costs of individual insurance plans on the exchanges go up so the system would collapse of its own weight. But the ACA salvaged itself, because even when premiums went up, the ACA also required that the federal subsidy keep pace, so costs didn’t really increase for subscribers. It was one resilient dang program.
As a Congressional Budget Office assessment explained in September 2018,
Although premiums have been increasing, most subsidized enrollees buying health insurance through the marketplaces are insulated from those increases because their out-of-pocket payments for premiums are based on a percentage of their income; the federal government pays the difference between that percentage and the premium for a benchmark plan.
Insurers’ uncertainty over continued federal support was the main source of those rate increases, but the CBO estimated that the market would stabilize all the same.
And by golly, it did. The ACA was designed to survive market turbulence, and darned if a lot of those features didn’t also make it resistant to intentional ratfucking. It kept doing what it was designed to do, though not as well, until Joe Biden was elected and got to work fixing the damage Trump did, as well as boosting the premium subsidies to make it more affordable (again). The ACA is now covering more people than ever, and the number of Americans without health insurance is at an all-time low.
Let’s not mess with that, huh?
[CBS News debate transcript]
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