JD Vance Explains Trump's 'Concepts Of A Plan' For Healthcare. They Are Bad Concepts Of Bad Plans!

Maybe they'll get much better as they become a plan, LOL.

Dr. Leo Spaceman: ‘What? This? No, no. I was at a costume party earlier this evening, and the hostess's dog attacked me so ... I had to stab it.’

We all had a good laugh last week when Donald Trump admitted during the debate with Kamala Harris that, after nine years, he still doesn’t have a plan to replace Obamacare with something much better and more affordable that would cover all Americans. You may recall that’s what he repeatedly promised to reveal back when he was running for president the first time, and never actually revealed even when Republicans came close to repealing the Affordable Care Act without any replacement.

Instead, he insisted at the debate that he has “concepts of a plan” and everyone laughed at him. And because she actually has a plan, Harris’s campaign is this week holding a whole bunch of swing-state events to discuss how she will extend and improve access to healthcare, in contrast to Trump’s plan to gut healthcare, starting with the ACA. Check the list and see if there’s an event near you!

Oh, but it also turns out that there’s more than just a few hints about what those concepts actually are, and you will not be at all surprised to learn they are in fact worse than the ACA because they’ll cost a lot more and cover fewer people. But they’ll make more money for big healthcare businesses, and that’s what counts as “better” for the GOP.

Vance was asked by NBC’s Kristen Welker what sort of concepts Trump was conceptualizing, and he explained, as obliquely as possible, that the concept would involve “deregulating insurance markets, so that people can actually choose a plan that makes sense for them.”

What that would translate, to, of course, would be a return to the bad old days before the ACA, as New York magazine’s Jonathan Chait explains that for anyone who didn’t have employer-provided health insurance, Medicare, or Medicaid, buying insurance on the private market was a nightmare if you weren’t young and healthy, the lowest risk pool for insurers. Older people who might need healthcare actually cost a lot to cover!

Cheap plans could be sold to people who were young and healthy. Oftentimes, those plans denied coverage for any preexisting condition, or had hidden limits on the amount the insurer would have to pay, so if you got very sick, you would discover you faced ruinous costs not coverage by your insurance.

Obamacare turned that dysfunctional individual market into a market that offered affordable plans even for people who aren’t young and healthy. It did this by restricting the degree to which insurers can charge higher rates based on age (they can only make older customers pay a maximum of three times the rate they charge young customers). More importantly, it prevented insurers from screening out customers with a preexisting condition or denying coverage for necessary procedures.

By expanding the risk pool to “nearly everyone,” and by subsidizing premiums based on income, the ACA made private insurance affordable for many more people, although young healthy folks found themselves paying more for plans that didn’t cover much of anything, which made many of them mad because they tended not to use a lot of healthcare services anyway.

Eliminating the regulations that make the ACA work would put us back in that old model, where people who need coverage can’t afford it, although that’s not how Vance framed it. No, you see, everyone would have a choice to be either young and healthy with low premiums, or to be old and sick and face the highest costs possible. It’s freedom! Vance explained to Welker that Trump simply wants to

“implement a deregulatory agenda so that people can pick a health care plan that fits them. Think about it: A young American doesn’t have the same health care needs as a 65-year-old American. And a 65-year-old American in good health has much different health care needs than a 65-year-old American with a chronic condition.”

This way, as long as you never need insurance coverage, you’ll pay very little and insurers will make loads of profits. And if you do get sick, shame on you, you should have made better choices and your prices will be far higher.

Vance was quite explicit about all that, while pretending that “pre-existing conditions” wouldn’t exclude anyone from getting insurance — they’d be able to get a policy, but they’d have such high costs that they couldn’t get treatment.

“We want to make sure everybody is covered, but the best way to do that is to actually promote more choice in our health-care system and not have a one-size-fits all approach that puts a lot of the same people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families.”

Again, it’s having everyone in the same risk pool that makes the ACA affordable, particularly with the premium subsidies. That’s how insurance works. The scheme Vance outlines here would mean that premiums would indeed come down for people who don’t need care, at least until they do, and then they’re screwed.

And as Brian Beutler points out at his Substack (paywalled), that basic outline for gutting the ACA is remarkably similar to what Project 2025 calls for, although as we all know Trump wants nothing to do with Project 2025 as long as it has that name on it.

In related news, congressional Republicans aren’t even waiting for the election to start planning how they’ll reverse another Biden-Harris healthcare achievement by trying to repeal the Inflation Reduction Act’s provision mandating Medicare negotiate drug prices with drug companies, to bring down costs for the government and for seniors on the most expensive drugs. Why? Because drug manufacturers deserve all the money they can extract from Medicare and from old people, duh, are you a communist?

So that’s two Republican “concepts” for the Harris-Walz campaign to let voters know Trump and his pals in Congress will pursue if they get the chance, the end.

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[Harris healthcare events (at Wisconsin Politics) / New York / MSNBC / Off Message (gift link) / Axios]

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