Donald Trump likes to say he's different from other Republicans -- that he wouldn't let people die in the streets because they don't have health care.
Trump is lying. And a new report shows it.
The report, which the nonpartisan Committee for a Responsible Federal Budget released on Monday, is the first formal effort to assess the impact of Trump's ideas for repealing and replacing the Affordable Care Act. That impact, according to the Center's analysis, would be devastating.
The number of people without health insurance would rise by something like 21 million people if Trump had his way. That would mean more financial hardship, less access to health care, and -- according to a large, if occasionally contested, body of research -- higher mortality. Trump's plan could also increase the deficit by somewhere between $270 billion and $490 billion over 10 years -- depending in part on how the repeal affected the rest of the economy.
These numbers are extremely rough, in part because Trump's "plan" is more like a set of talking points than a detailed proposal from which analysts could make a firm projection. And in theory, Trump's new health care plan could increase the deficit by less -- or even create a surplus -- with huge cuts to Medicaid, the government program that provides health insurance for the poor. But significantly reducing what the federal government spends on Medicaid would mean significantly reducing access to care for millions of Americans now on the program. That group includes children and pregnant women, the disabled, the elderly, and adults who have jobs but simply can’t afford insurance.
For months, Trump paid lip service to the idea that he believed in universal health care, vowing to replace Obamacare, which he calls a "disaster," with "something terrific." But when Trump finally published an outline of his plans for health care two weeks ago, it didn't differ much from what other high-profile Republicans, including House Speaker Paul Ryan (R-Wis.) and some of Trump's rivals for the GOP presidential nomination, have proposed before.
Specifically, Trump would replace the Affordable Care Act's generous tax subsidies for people buying insurance with a tax deduction that would offer far less help to the people who need it. And while Trump previously said he'd protect people with pre-existing conditions, the plan he published on his website would repeal regulations requiring insurers to sell to all people regardless of medical risk. It would also eliminate requirements that insurers offer uniform premiums that vary only by age, tobacco use and geography.
Trump would then allow insurers to sell coverage across state lines, so that insurers could gravitate to the states with the fewest rules about benefits and pricing -- much like credit card companies have gravitated to states with the weakest financial regulations -- and sell from there.
It would be quite the one-two punch. First, Trump would return the health care system to its pre-Obamacare status -- a time when insurance companies could pick and choose whom to insure, when many millions were priced out of coverage altogether. Having done that, Trump would further weaken the ability of states to police their own health care markets.
Of course, the trick with evaluating any Trump proposal is that it's not clear he's actually given the idea much thought -- let alone whether he'd actually try to enact it if he were elected. But because his ideas about health care overlap so much with what mainstream Republicans have offered over the years, it's easy to imagine a President Trump signing off on whatever schemes the GOP Congress might produce.