The Trump/Vance plan to destroy Obamacare

Vice presidential candidate J.D. Vance repeatedly lied during the debate to hide the GOP's intention to bring back junk health insurance plans.

During the vice-presidential debate, Senator J.D. Vance issued a thinly veiled promise to the nation’s insurance industry that after a Donald Trump win, the GOP will move aggressively to destroy Obamacare and open the door for junk insurance purveyors. He did so while also asserting that the former president had “salvaged” Obamacare while in office—a claim so audaciously absurd, yet delivered with such banal wonkery, that millions of average viewers might well have believed him.

Did you really just say Trump salvaged Obamacare?

It’s worth quoting his claim that night in full:

Donald Trump has said that if we allow states to experiment a little bit on how to cover both the chronically ill, but the non-chronically ill, it’s not just a plan. He actually implemented some of these regulations when he was President of the United States. And I think you can make a really good argument that it salvaged Obamacare, which was doing disastrously until Donald Trump came along. I think this is an important point about President Trump… A lot of what happened and the reason that Obamacare was crushing under its own weight is that a lot of young and healthy people were leaving the exchanges. Donald Trump actually helped address that problem, and he did so in a way that preserved people’s access to coverage who had pre-existing conditions

That entire statement is a lie. First, his administration backed the GOP-run Congress’ attempt to repeal the Affordable Care Act. Only John McCain’s courageous thumbs-down vote saved the program. Then the Trump administration made a series of regulatory changes that threw millions of people off the insurance roles. He also promoted alternative plans certain to leave them with unaffordable co-pays and deductibles and huge medical debts when they became seriously ill. Finally, Trump encouraged some young people to forgo insurance by eliminating the individual mandate in his 2017 tax-cuts-for-the-wealthy act.

Kamala Harris’ running mate, Tim Walz, did a good job reminding debate viewers about the GOP’s nearly successful attempt to repeal Obamacare during Trump’s first two years in office. Unfortunately, Walz failed (perhaps because the debate’s format gave the candidates so little time) to highlight how much enrollment fell during Trump’s first three years in office. More importantly, he didn’t counter Vance’s “salvaged Obamacare” lie. He might have listed the numerous steps Trump took to undermine the program. They include:

• Shortening the enrollment period from 3 months to 6 weeks.

• Cutting the advertising budget during the ACA enrollment period by 90% and sharply curtailed funding for the navigators who help people sign up.

• Eliminating cost-sharing reduction payments to insurers so low-income enrollees would have lower out-of-pocket costs.

• Eliminating the individual mandate, which the Congressional Budget Office estimated decreased enrollment by 3 to 6 million people and increased plan costs by about 10%.

• Allowing greater use of “association” plans for small businesses and self-employed individuals, These plans exclude ACA-mandated benefits and

• Backing the legal challenge to the ACA which Trump appointees to the Supreme Court partially endorsed in 2020, allowing states that refuse to expand Medicaid to continue receiving federal funds.

The cumulative effect of those administration moves reduced overall enrollment in Obamacare by over two million people. Trump didn’t salvage the program. He savaged it.

We’ve seen this “concept of a plan” before

The Trump administration also succeeded in “lessening the regulatory burden” on insurers by expanding access to short-term health plans with limited benefits. How? By lengthening their maximum duration from 3 months to 3 years. These plans provide less comprehensive coverage than ACA-compliant plans by eliminating free access to highly-rated prevention services like flu shots and mammography. They also can include very high out-of-pocket costs.

The Biden/Harris administration has executed a 180-degree reversal of the Trump changes with overwhelmingly positive results. Through higher subsidies included in the 2021 American Rescue Plan Act, which were extended by the 2022 Inflation Reduction Act, more than 10 million additional people have purchased health plans on the Obamacare exchanges, a near doubling of the final count during the Trump era after his changes had caused millions of people to drop coverage. The nation’s uninsured rate under Biden/Harris fell to 7.7%, down from 9.2% in 2019, the year before the pandemic.

Vance said Trump’s “concepts of a plan” for the future of the ACA would allow insurers to sell these skimpy plans on the exchanges, which is currently forbidden. This would allow younger and healthier people to buy low-cost plans with high deductibles. This would force older and sicker people into separate, higher-risk, and therefore more expensive pools. To repeat what Vance said: Trump wants to “allow states to experiment a little bit on how to cover the chronically ill but the non-chronically ill.”

As Walz pointed out, bifurcated risk pools were essentially what existed in the individual plan market before Obamacare. Such plans were widely judged a complete failure. They had extremely high premiums, leaving their sicker clientele with unaffordable co-pays and deductibles. They contained annual and lifetime limits on coverage, which was a disaster for the sickest patients with multiple chronic conditions. They also allowed for exclusions based on pre-existing conditions.

Even if Trump left the federal pre-existing conditions in place, which Vance promised, it would only apply to exchange plans. Allowing states to “experiment” with skimpy plans would encourage millions of younger, healthier people in those states to flee the exchanges. This would make useful coverage under the ACA unaffordable for older, sicker people or require massive increases in federal subsidies for what the ACA would become: a national high-risk pool. How likely is a GOP Congress to support that?

Ironically, neither vice presidential candidate mentioned the biggest threat facing the ACA’s insurance expansion under the Biden/Harris administration. The 2021 American Rescue Plan Act and Inflation Reduction Act lowered the percentage of income a person had to pay for silver plans on the exchanges. It also removed the income cap for subsidies, which had been set at 400% of the federal poverty level. These expanded subsidies were largely responsible for the rapid expansion of Obamacare in the past three years, to October of 2025.

But with their expiration set for a year from now, who controls Congress and the White House next year will largely determine Obamacare’s fate. Will Congress vote to maintain the expansion and thereby fulfill Obamacare’s promise to end the enduring stain on America’s reputation as the only country in the advanced industrial world that fails to provide universal health insurance? Or will coverage decline as it did under Trump when he held the highest office in the land? Based on what J.D. Vance told nationwide viewers this week, a GOP win will ensure that the U.S. continues to be an outlier nation with little concern for the sickest and poorest among us.

This article appeared first on the Washington Monthly website.