The joke is too easy: President Trump typed “HealtCare” on April 1 when he tweeted about his latest plan to replace the Affordable Care Act with something better. Republicans can’t even spell health care correctly.
Typos aside, there’s an opportunity for Trump and his fellow Republicans if they were to get serious about a health care plan that would lower costs and cover more people. The Trump administration has now joined a lawsuit to strike down the ACA, and Trump has promised to make the GOP “the Party of Great HealtCare (sic).” Trump clarified that Republicans won’t promote a new health care plan until after the 2020 elections. But that means Trump will have to tell voters what his plan is, assuming it’s not, ahem, all just a sham.
Democrats think they own health care as an issue—largely because retrograde Republicans have no coherent plan except to go back to the way it was before the ACA. But it’s not yet clear that Dems have developed a workable, next-generation health care plan voters will like. The ACA has gained popularity since Congress passed the controversial law in 2010, and it has also helped around 20 million Americans get coverage. Yet health care is still the top problem voters worry about. Costs are too high, even for those with coverage, and financial catastrophe awaits those who get sick or hurt without adequate insurance.
The Medicare-for-all plan developed by Vermont senator Bernie Sanders is now backed by at least 7 major Democratic presidential candidates. But it hasn’t caught on with voters yet—and might never catch on—because it would require sharp tax increases and force millions of Americans off private health plans they like. There are more modest Democratic plans, but they’re less well-known and don’t have pithy names or famous champions.
Opportunity for Trump
This is where there’s opportunity for Trump. There are many good ideas for lowering costs and expanding coverage that don’t involve expanded government programs. Republican Sen. Lamar Alexander of Tennessee, for example, recently asked two think tanks—the American Enterprise Institute and the Brookings Institution—for suggestions on how to improve the U.S. health care system. A bipartisan group of experts came up with nearly 20 recommendations. Examples: End tax breaks that encourage overconsumption of care, bust health care monopolies and change Medicare incentives to encourage greater use of generic drugs.
If Trump wants to get serious about health care reform, he should grab ideas like those and stop trying to kill the ACA. “Repeal and replace” is a combat slogan meant to fire up conservatives who object to big government. It has the equal and opposite effect of rallying liberals to the defense of the ACA. Any proposal to repeal the ACA can’t possibly earn bipartisan support, because the starting point is partisan warfare. Voters want pragmatic solutions on health care, not zero-sum ideology.
The ACA also includes sensible reforms that have benefited millions of American families, with almost no downsides. It prevents insurers from excluding coverage on account of pre-existing conditions, one of the most hated elements of the U.S. health care system prior to the ACA. It lets adult kids stay on their parents’ plans until age 26. Preventive services are now required, without cost sharing. And there are prohibitions on annual or lifetime coverage limits.
When Congressional Republicans tried to repeal the ACA in 2017, their pitch to voters was “trust us.” Republicans are lucky the late Sen. John McCain voted against that plan, essentially killing it. He saved Republicans from plunging the U.S. health care system into chaos and having to defend what would have been countless awful stories of suffering, bankruptcy and death caused by GOP legislation.
Other GOP efforts to “reform” health care—health-savings accounts, Medicaid work requirements, offering insurance across state lines—are mostly benefit-cutting efforts in disguise. These ideas typically rely on free-market magic to stretch the health-care dollar further, which in turn justifies cutting existing programs like Medicaid, Medicare and the ACA. This approach would be fine if you instituted said reforms and only cut corresponding programs once the new benefits materialized. But Republicans usually want to cut the old program and institute the new program at the same time, which makes voters rightfully suspicious of a bait-and-switch.
Trump and his fellow Republicans need to accept the reality that the United States is moving toward some form of universal coverage, which means everybody will have access to health care, one way or another. That might eventually take the form of a single-payer program run entirely by the government. A more pragmatic approach would be to leave the private system in place, while offering new cost controls and safety nets for those who need them.
Republicans will prove they’re serious about health care when they start coming up with ways to control costs and cover more people, without taking benefits away from anybody in the bargain. Trump often makes grandiloquent claims he never bothers to back up with action. He may be doing the same thing now with “HealtCare.” But there are genuine problems to solve — and voters who will reward whichever party can do it.
Rick Newman is the author of four books, including “Rebounders: How Winners Pivot from Setback to Success.” Follow him on Twitter: @rickjnewman