The miseducation of Donald Trump: Understanding Obamacare is not a preexisting condition for its opponents

Someone tell Trump the Affordable Care Act is a Jenga puzzle: Remove a few blocks and the whole thing falls apart

Published November 28, 2016 9:59AM (EST)

 (AP/Evan Vucci/Jim Cole)
(AP/Evan Vucci/Jim Cole)

Speaker of the House Paul Ryan has already pledged to not only repeal Obamacare as one of his agenda priorities, but he’s also planning to move forward with his long-awaited privatization of Medicare. There are myriad problems with these goals, beginning with this: Ryan, who vocally hates the Affordable Care Act, is proposing to phase out Medicare as we know it and replace it with private insurance policies and subsidies for seniors to help with the premiums. Put another way: The Obamacare-hating speaker wants to change Medicare to look like Obamacare.

While we’re talking about A-list leaders who have something to say about whether I and 20 million other Americans will continue to be able to buy affordable health insurance that we like, it’s important to emphasize that neither Donald Trump nor "60 Minutes" reporter Lesley Stahl were able to talk about the law with any accuracy. During the president-elect’s only post-election interview, Trump said he’d like to keep the section of the law about “kids living with their parents.” Read the law: It doesn’t say a damn thing about kids living with their parents.

Trump also agreed with Lesley Stahl’s suggestion about “preconditions.” What the hell is a precondition? Again, American leaders — press and political alike — who don’t know how to talk about the law. This is terrifying.

Welcome to yet another debate over what to do about health care. To paraphrase “Macbeth”: It’s a tale told by idiots, full of sound and fury, amounting to nothing. And let’s hope that second part is true, that there will be minimal changes.

At this point, it can go either way.

It’s possible, though unlikely, that President Barack Obama’s informal tutoring of Donald Trump will dissuade the president-elect from taking any action at all. Already, during the "60 Minutes" appearance, Trump backed down from a complete repeal. It’s obvious, if we decipher what he said, that he wants to leave in place the ban on denying coverage to customers with preexisting conditions and wants to continue allowing kids to remain on their parents’ insurance until age 26 (they can choose to live at home or wherever they want).

What he might not fully understand yet is that in order to keep the preexisting condition section of the law, he also has to keep the relatively unpopular individual mandate section. The reason being, without the mandate, people would only buy insurance after they’re sick or injured, hence gaming the system. Furthermore, if he keeps the preexisting condition language and the mandate, he’ll have to keep the subsidies and the Medicaid expansion, otherwise lower-income Americans won’t be able to afford the mandatory premiums.

This is how the health care Jenga puzzle works. Remove a block and the whole thing falls apart. Maybe that’s the point. If Trump and the congressional Republicans repeal sections of the law (namely the subsidies and the mandate since each prong is linked to the budget) via a 50-plus-1 reconciliation vote in the Senate, they’ll infuriate the $900 billion health insurance industry by forcing insurers to accept patients with preexisting conditions but accompanied by a massive loophole created via the repeal of the mandate.

In case you didn’t notice, the Patient Protection and Affordable Care Act is more than a little complicated. Health insurance in general is confusing by itself, but when we combine the viral confusion with the incendiary rage experienced by certain Americans when the word Obamacare is mentioned in public, we have a toxic cocktail of fear, anger and confusion. Americans have an insufferable tendency to do crazy things when they’re scared, angry and confused. With Obamacare, the dominant reaction is to kill it — stupidly.

Consider that 48 percent of Americans, according to poll aggregator Real Clear Politics, oppose the law, while 51 percent would like Trump and Republicans to repeal the law. But there’s an infuriating disconnect staring us in the face. About 12 million Americans have purchased insurance plans on either or through state-run marketplaces. If we include children remaining on their parents’ insurance, along with new Medicaid subscribers, the total number of the ACA-insured rises to about 20 million Americans. That’s a lot.

The uninsured rate, as a consequence of the ACA, has dropped to an all-time low of 8.6 percent. That means only a minuscule fraction of people who hate the law are actual Obamacare users. The majority is telling a small minority of ACA users that they’re not allowed to have insurance they like because reasons.

Oh, and by the way, you’d never know this from the cable news coverage but among people who use the ACA to buy insurance, the approval rating for the law is around 86 percent. In other words, people who don’t use the ACA hate the law, while people who use the ACA tend to love it.

This is not unlike saying we should burn all Prince records because people who don’t even listen to Prince hate his music. In fact, there are tens of millions of non-Obamacare users who have insurance through their employers who also happen to be benefiting from the law’s ban on lifetime limits on coverage; its ban on rescission, which formerly allowed insurers to cancel coverage after patients were sick or injured; its ban on excessive co-pays and co-insurance; and so forth.

The only non-Obamacare users who might have a gripe or two are Americans making more than $250,000. Their Medicare taxes go up a little. Oh, and people who use tanning beds are charged more. That’s all. It was either that or all of us would’ve continued to pay higher prices for medical coverage that was far worse and that covered less than current policies under the ACA.

Speaking of Medicare, many of the retirees who use Medicare and who inexplicably voted for Trump will be surprised to learn that the ACA extended the solvency of Medicare by 11 years. Secondarily, the ACA has begun to close the Medicare Part-D “doughnut hole” — the gap in prescription drug coverage that formerly forced seniors to either pay out of pocket for meds or to go without. If the ACA is repealed, the doughnut hole pops wide open again. How many pro-repeal voters are aware of this? Clearly very few. Indeed, neither Trump nor Paul Ryan has mentioned the doughnut hole. Instead, they’re lying to their people and telling them that the ACA has siphoned $700 billion from Medicare. It’s a claim that’s been repeatedly debunked. The ACA doesn’t cut Medicare at all. According to Politifact:

While the health care law reduces the amount of future spending growth in Medicare, the law doesn’t actually cut Medicare. Savings come from reducing money that goes to private insurers who provide Medicare Advantage programs, among other things. The money wasn’t “robbed.”

Despite reality, Paul Ryan continues to market the lie, even though it was thoroughly shot down more than four years ago. Both and The Washington Post’s fact-checker, Glenn Kessler, have agreed. Though it's not like fact-checking matters in the age of fake news and the Trumpers who benefit from it.

Adding to the soul-crushing misinformation and agitprop, most Americans who don’t have to deal with the law in any way also don’t fully understand the name of the law. The name. As you might recall, several polls conducted in 2013 discovered that 46 percent of Americans dislike Obamacare, while only 37 percent of Americans dislike the “Affordable Care Act.” (In case you’re just joining us, the Affordable Care Act is Obamacare. They’re literally the same thing, regardless of your feelings about President Barack Obama.)

Also lost in the bottomless pit of ACA lies and misinformation is the reality that the premium hikes being discussed recently would have been significantly higher if the ACA didn’t exist. The ACA never promised premiums that would go down every year; it only promised to bend the cost curve to slow the rate of increase. For millions of ACA marketplace subscribers, however, rates won’t change at all due to the existence of subsidies. Talking Points Memo reported: “The HHS estimated that 72 percent of current ACA marketplace enrollees will be able to find a plan for less that $75 a month, after the tax credits are applied.”

If you’d prefer to see rate hikes that are actually punitive, wait until Paul Ryan dumps elderly Medicare recipients into the private insurance market. Not only will the cost to the government for subsidized private insurance remain roughly the same as Medicare in its current form, but seniors would end up paying about $200 more a month out of pocket. Ryan’s plan is basically to sabotage Medicare in order to slowly kill it.

While Trump has expressed opposition to meddling with “entitlements,” he might be too lackadaisical to bother in the face of congressional Republican support for privatization. It’s also worth noting that Mike Pence pledged on "Fox News Sunday" that an ACA repeal is the administration’s first order of business. Coupled with the fact that repealing the ACA would reopen the doughnut hole and reintroduce wasteful Medicare scams, it looks like Medicare will be attacked from both ends — via an ACA repeal and Ryan’s ludicrous Medicare privatization.

Meanwhile, news about the battle will surely be circulated in ways that will only worsen citizen ignorance about the Trump GOP’s ill-conceived plans. If the president-elect can’t accurately talk about it, if Speaker Ryan is deceiving his people about it, if "60 Minutes" anchors don’t understand it and if voters who don’t have anything to do with the law are impulsively and vindictively deciding its fate out of staggering levels of ignorance, then it doesn’t look good for either Medicare or the ACA. Elections matter, and this one truly enabled and empowered the level of American health care stupidity.

By Bob Cesca

Bob Cesca is a regular contributor to Salon. He's also the host of "The Bob Cesca Show" podcast, and a weekly guest on both the "Stephanie Miller Show" and "Tell Me Everything with John Fugelsang." Follow him on Facebook and Twitter. Contribute through LaterPay to support Bob's Salon articles -- all money donated goes directly to the writer.


Related Topics ------------------------------------------

Donald Trump Elections 2016 Medicare Obamacare Paul Ryan The Affordable Care Act