And That's How Donald Trump Solved 'Healthcare'
It'll be great, fuck it, why not.
Donald Trump has been spewing random thoughts on his fake Twitter account again, and because Dear Leader’s whims apparently have the force of law, once-respectable media organizations are writing about whatever dumb shit comes out of his facehole as if it were truly “policy.” Which of course makes the dumb rants more likely to become policy, because so many people are sure that anything Great Leader says is a terrific idea. Please never mind that the rants erupted from Trump’s rage over the government shutdown, which thanks to eight feckless “moderates” is likely to be over before any of Trump’s ideas can be turned into action.
On Saturday, Trump shat out a great idea for reforming healthcare: Eliminate the Affordable Care Act, and then take the money that partly subsidized premiums for Obamacare’s individual policies and just distribute it to people so they could make *their own* healthcare choices.
Presumably the folks freed from the tyranny of Obama care would go, one by one, to purchase insurance from the same “money sucking Insurance Companies” Trump wants to cut out of the system. Or maybe the money would go to an individual health savings account people could use to pay for part of one serious accident or illness and then go bankrupt. Or maybe it would be that one-time payout of $2000 Trump also blurted about, and people could buy insurance for their entire family (as if!) or just blow it on paying other bills and hope they never get sick. Or maybe Republicans will just kill off the ACA and nobody will get any payout, that could be it, too.
Instead of treating Trump’s ignorant rants as ignorant rants, news outlets dutifully reported that Trump had issued a serious policy proposal about healthcare that he expects his underlings to put in place. Will those “proposals” have any life expectancy beyond the end of the shutdown? That depends on where Trump’s whims go next.
Here’s CNN taking Trump seriously on the ACA subsidies rant:
President Donald Trump has floated a proposal to put the billions of dollars that back Affordable Care Act tax credits directly in the pockets of Americans instead, as lawmakers have so far failed to find a solution to address the rapidly approaching expiration of the enhanced subsidies that is at the heart of the record-breaking shutdown stalemate.
Trump urged Senate Republicans in a Truth Social post on Saturday to send the money used to offset the costs of ACA health care premiums “directly to the people” so they can “purchase their own, much better, health care.”
The Washington Post similarly reported that Trump “urged Senate Republicans to redirect funding for Affordable Care Act subsidies away from health insurers and toward average Americans,” and framed it as a tactic to pressure Democrats into voting to end the shutdown.
And because there’s no idea too stupid for Republicans, both stories reported that Sen. Rick Scott (R-Medicare Fraud) claimed on Twitter that he was “writing the bill right now” (archive link). Scott may have been referring to a stupid idea he mentioned in late October, which would magically replace ACA subsidies with cash to current ACA enrollees instead. Scott gushed to Fox Business’s Maria Bartiromo, “We could fix health care pretty simple. Let’s just say, let people buy what they want to buy. If you’re entitled to a subsidy under the original Obamacare, give it to you in cash so you’re a buyer of health care.” That way, he claimed, people “can buy health care cheaper many times if you just go buy it yourself, rather than go through an insurance plan,” even though that has never actually been the case in the real world.
On Sunday, Trump claimed in another Truthshart (archive link) that the ACA subsidies could be redirected to the individual health savings accounts (HSAs) set up by the shitty Big Blowjobs for Billionaires bill, although of course the post was short on details about who would qualify and how any of it would work. Trust him.
Remember, nobody has any idea if any of it adds up to a “plan,” or even a concept of a plan, or whether Donald Trump intends to support Scott’s half-baked idea. But the vague outlines sound similar, so now Politico is reporting that Republicans are — maybe! — “pivoting” from extending the existing subsidies for ACA premiums to offering a whole new healthcare system instead, and one idea they’re pitching is “the creation of new health savings accounts.”
Never mind that making millions of Americans individually pay for healthcare would abandon the risk pool price savings of insurance as we know it now — to say nothing of the greater efficiencies of a good universal coverage system that negotiates standard provider costs. As MSNBC notes,
GOP policymakers have often championed HSAs because, in theory, they reflect Republicans’ preference for individuals’ choices over government intervention. In practice, HSAs tend to benefit people with higher incomes: They’re the ones with the means to contribute to the accounts, and because they’re in higher tax brackets, they benefit more from each dollar saved. Furthermore, researchers at the Center on Budget and Policy Priorities find that HSAs do not significantly benefit those who struggle with health care costs, and relatedly, that they exacerbate the racial disparities the ACA has effectively reduced.
It’s all just vapor at this point, but that’s the magic of Trumpian vagueness. He tosses out a ridiculous brainshart like “let’s give individuals all the ACA subdsidies,” and his minions dust off whatever Heritage Foundation white paper they’ve been hoping to push.
The flavor of the day just might be HSAs for everyone! Or maybe just for everyone now on the ACA. Or maybe most of the funding for ACA subsidies will be redirected to deporting people, and a few scraps will provide seed money for accounts that anyone can “choose” to buy into, if they can afford it.
Whatever rough beast slouches out of Trump’s shutdown-driven half-idea, if any, will find a way to eliminate the fairly effective but flawed ACA, and make healthcare shittier for most Americans, but more profitable for whoever provides the next flavor of snake oil. You can bank on that.
[CNN / WaPo / NBC News / Florida Politics / Politico / MSNBC /
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Just wanted to add that a good employer-paid HSA is one of the best things about working here at Wonkette, because it's in addition to good insurance coverage. But on its own, and relying on the employee to put money into it instead of frittering it away on rent and groceries, it would be no replacement at all for insurance. And of course single-payer with price controls beats any private insurance (unless it's run by a grifter)
Grrr, updated with correct links to Florida Politics blog re Scott's dumb talk with Bartiromo in October.
https://floridapolitics.com/archives/762155-pretty-simple-rick-scott-backs-cash-payouts-to-replace-affordable-care-act-subsidies/