Donald Trump broke the first campaign promise he made about Obamacare when he couldn’t scrap the law on the day he took office.
He’ll get another chance to make good on the pledge this week, if the House takes up a revised repeal-replace plan. But the version of the legislation he’s endorsing undermines other key promises candidate and President-elect Trump made about the cost and quality of health care in America — not to mention the way he said he’d bring about change.
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The Trump administration recognizes the perils of over-promising on health care. Voters punished Democrats after then-President Barack Obama’s pledge that “if you like your health plan, you can keep your plan” was proven false. Obama’s promise was eventually deemed “lie of the year” by PolitiFact.
“Where they erred last time … they made promises they couldn’t keep,” White House press secretary Sean Spicer said last month.
But some representations Trump and his team have made will be impossible to keep if the GOP bill becomes law. Here are five that won’t materialize:
A plan that ‘will be every bit as good on pre-existing conditions as Obamacare’
That’s the pledge the president offered on Monday, in an interview with Bloomberg News.
It was his latest vow to protect people with chronic illnesses, despite language in the House plan that would allow states to opt out of Obamacare’s requirement that all consumers be charged the same for coverage, regardless of health history. The policy shift envisions pushing sicker people into high-risk insurance pools and making plans significantly more expensive for that population. AARP estimates that premiums for the sickest patients in some states that chose to waive Obamacare requirements could reach $25,700.
Trump seemed to acknowledge that reality Monday, when he told Bloomberg that the bill is “not in its final form right now,” and promised unspecified changes that would protect Americans with pre-existing conditions as well as Obamacare does. “I want it to be good for sick people,” he said.
On Saturday, Trump told CBS’ “Face the Nation” that the bill included a “clause that guarantees” coverage for patients with pre-existing conditions, then reversed himself by the end of the interview.
Numerous Republicans have made similar vows at town meetings and in interviews. Those who have declined to endorse the repeal bill, moreover, have cited its failures to adequately preserve the Obamacare protections. “The proposed changes to this bill would leave too many of my constituents with pre-existing conditions paying more for health insurance coverage and too many of them will even be left without any coverage at all,” said Rep. Ileana Ros-Lehtinen (R-Fla.).
‘Insurance for everybody’
The promise, made in an interview with The Washington Post a week before the inauguration, was one Trump’s advisers almost instantly began walking back and is at odds with the House repeal bill. The GOP package could result in at least 24 million fewer Americans being covered a decade from now, according to projections made by the nonpartisan Congressional Budget Office.
‘No cuts’ to Medicaid
As a candidate, Trump repeatedly pledged that he wouldn’t touch the health entitlement for the poor, which was expanded under the Affordable Care Act and has been frequently targeted by Republicans.
But the House bill would slash $880 billion from Medicaid, according to the CBO’s analysis, and leave millions of Americans who benefited from the Medicaid expansion without coverage. That’s one reason why the bill has clear “problems,” Rep. Charlie Dent (R-Pa.), co-chair of the moderate Tuesday Group, told POLITICO’s “Pulse Check” podcast last month.
‘No lines’ for health insurers
As a candidate, Trump repeated this vow so often that rival Sen. Marco Rubio asked if it was his entire health plan.
Trump insisted that the policy was central to health reform. “When you get rid of the lines, it brings in competition,” he said in a February 2016 debate. “So instead of having one insurance company taking care of New York or Texas, you’ll have many. They’ll compete. And it will be a beautiful thing.”
However, Republicans’ bill doesn’t make such changes to the insurance market. The White House says that those reforms will come later, in a yet-to-be-finalized phase of health reform.
That hasn’t stopped the president from taking credit for the change right now. “We’re taking across all of the borders or the lines so that insurance companies can compete nationwide,” Trump said on “Face the Nation,” before being immediately corrected.
‘No one will lose coverage’
Trump’s lieutenants also have made promises that can’t possibly be kept. Counselor Kellyanne Conway promised in January that “no one will lose coverage” under Republicans’ bill. And HHS Secretary Tom Price told NBC’s “Meet the Press” that “I firmly believe that nobody will be worse off financially in the process that we’re going through.” Such claims are undercut by the CBO analysis.