Trumpcare: Fiction and Fact

http://www.nytimes.com/2017/03/13/opinion/trumpcare-fiction-and-fact.html

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Watching administration officials play cat and mouse with Sunday talk show hosts is a hoary Washington tradition. But yesterday, Trump spokesmen offered a remarkably large number of flat out untruths as they attempted to defend the Republican health care plan.

Untruth #1:

“I firmly believe that nobody will be worse off financially in the process we are going through.” – Tom Price, Secretary of Health and Human Services, on Meet the Press.

Fact #1:

Millions of Americans will be worse off. For those currently purchasing insurance on the exchanges using Federal subsidies, that support will be replaced by tax credits that, for many, will be substantially smaller, as this chart shows:

For those in the 31 states and the District of Columbia that are participating in the Medicaid expansion, Trumpcare will provide far less Federal support, as the chart below indicates. After 2020, states will no longer be able to accept additional enrollees and no one who loses eligibility (such as by getting a higher paid job) will be able to return to the program even if their income drops. All told, the Administration plans to save $370 billion over the next 10 years from these cuts – which will surely make many Americans worse off.

Untruth #2:

“The fact that certain groups will pay less tax is not…central to the issue. We’ve done this in a fashion that allows the people who cannot afford health care now to afford it.”

—Mick Mulvaney, director of the Office of Management and Budget on This Week

Fact #2:

That’s two misstatements in quick succession. The plan to repeal $600 billion of taxes that almost entirely benefit the wealthy is very much at the heart of the matter. Those revenues are currently being used to expand Medicaid for the poorest Americans and subsidize health insurance for families with incomes between $24,600 and $98,400 per year. Removing a large chunk of those subsidies surely makes health care less affordable for those with lower incomes.

Untruth #3:

“The number of individuals who actually got coverage through the exchange who didn’t have coverage before…is relatively small.”

—Mr. Price on Meet the Press

Fact #3:

What is he talking about? Of the 11 million people who are buying health insurance coverage through the exchanges, all but 1.7 million are receiving subsidies through Obamacare. As the drop in the total number of uninsured indicates, it’s impossible to imagine that most of them were previously buying unsubsidized insurance directly from providers.

Untruth #4:

“The President is focused on health care, not insurance coverage.”

—Mr. Mulvaney on This Week.

Fact #4:

President Trump was very clear during the campaign: “We’re going to have insurance for everybody,” he said in an interview with the Washington Post on January 14. “Much less expensive and much better.” According to early estimates from Standard & Poor’s and Brookings, between six and 15 million Americans would lose insurance coverage under Trumpcare.

Even House Speaker Paul Ryan, appearing on Face the Nation, seemed to acknowledge that some who currently have health insurance would lose it. “I can’t answer that question,” he said. “It’s up to the people.”

Untruth #5:

“If you want to have coverage – and we think that everyone should have coverage – we’re providing you access to coverage.”

—Gary Cohn, director of the National Economic Council, on Fox News Sunday

Fact #5:

That’s technically true but of course, with or without any federal assistance, individuals are always free to buy health insurance. Mr. Cohn’s comment came in response to repeated questioning by host Chris Wallace about what would happen to the more than 20 million people who have gained coverage under Obamacare. As noted, it’s inconceivable that millions of Americans who are currently insured won’t lose their coverage.

Untruth #6:

“I love the folks at the C.B.O. … but sometimes we ask them to do stuff they’re not capable of doing and estimating the impact of a bill of this size probably…isn’t the best use of their time.”

—Mr. Mulvaney on This Week.

Fact #6:

Estimating the impact of proposed legislation is precisely what the Congressional Budget Office was set up to do back in 1974. And while the C.B.O.’s early estimates of the impact of the Affordable Care Act were, in fact, slightly optimistic, they were closer to the mark than many other forecasters, as this chart shows:

Evaluating complex policy proposals is, indeed, difficult but Mr. Mulvaney’s apparent preferred alternative – doing no impact analysis at all – makes no sense. Just because weather predictions are often wrong, would you not check the forecast before you venture outside?

Finally, a reminder to Mr. Mulvaney: The current director of the C.B.O., Keith Hall, was picked by the Republican leadership on Capitol Hill and served in the administration of President George W. Bush.

Untruth #7:

“Obamacare…is blowing up our fiscal problem.”

—Mr. Ryan on Face the Nation

Fact #7:

The Affordable Care Act was crafted with a mix of tax increases and Medicare cost cuts alongside the new benefits in order to – shockingly – provide a modest amount of deficit reduction. Over its initial decade, the entire Obamacare package was projected to reduce the total deficit by $124 billion. In addition, in its most recent assessment, the C.B.O. said repealing Obamacare would increase the deficit by $353 billion between 2016 and 2026.

Furthermore, the net expenditures on coverage have been revised down several times. In 2010, the C.B.O. projected that benefit costs would total $132 billion in 2016; by last year, that estimate had been reduced to $110 billion.

Untruth #8:

“Obamacare is just not working. You know, in the last year alone, premiums are up 25 percent.”

—Mr. Cohn on Fox News Sunday

Fact #8:

That often-cited statistic applies only to individuals who buy unsubsidized insurance through the exchanges (1.7 million people) and those who get their insurance directly from providers (another six million Americans). These two groups account for just 3 percent of Americans.

And while by talking about “last year alone,” Mr. Cohn implies that this is the latest of a long string of large increases, in fact, premiums increased by 7 percent in 2016 and 2 percent in 2015.

Untruth #9:

“The people who are just above Medicaid but still have difficulty buying their own premiums will…have the ability to use [Health Savings Accounts] to pay for their…healthcare on a tax-advantaged basis.”

—Mr. Mulvaney on Meet the Press

Fact #9:

He is talking about people whose incomes are well below median levels and is offering them the opportunity to save money they don’t have and get the benefit of taxes they generally don’t pay because their incomes are too low. How does taking away the Obamacare benefits and giving them refundable tax credits of $2,000 to $4,000 per person replace subsidies that currently run to as much as $9,874 for older low-income individuals?

Untruth #10:

“I was on Obamacare when I was in the House. My family’s deductibles were over $15,000 a year.”

—Mr. Mulvaney on Meet the Press

Fact #10:

Mr. Mulvaney didn’t provide enough information for me to be sure but for one thing, the out-of-pocket maximum for a marketplace plan in 2016 was $13,700. For another, while Mr. Mulvaney is correct that senators and representatives are required to buy their insurance through the District of Columbia exchange, they get a pretty good deal.

According to Congressional Research Service, if they buy a gold plan, the government (meaning us taxpayers) paid up to 75 percent of the premiums. I went to the District of Columbia health care exchange and for a family of 5, like the Mulvaneys, the yearly cost of plans currently being offered is approximately $25,000. That would mean premium costs of just over $6,000 a year. The required deductibles range from zero to $2,000. So I have no idea where Mr. Mulvaney’s assertion came from.

Untruth #11:

Kentucky is a “textbook case of Obamacare’s failures.”

—Vice President Pence in Louisville on Saturday

Fact #11:

While not said on a Sunday show, Mr. Pence’s comment must be noted. In fact, Kentucky has seen the largest drop of any state in the uninsured rate under Obamacare, as this chart shows: