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That issue is Obamacare. For years, railing against it helped Republicans. Then they took power and tried to repeal it, at which point voters began to focus on specific health-care benefits they valued. The polling turned ugly, and Republicans could not reach a consensus on how to replace Obamacare. A 2017 no vote from Sen. John McCain (R-Ariz.) dealt a killing blow to the effort, and Republicans haven’t raised it again since.
Until now. Trump recently said he is “seriously looking at alternatives” and still wanted to “terminate” the program. The Biden campaign responded that what Trump really wants to terminate are the health-care plans of millions of people, particularly those with chronic illnesses.
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Trump didn’t have to make Obamacare an issue again. It was the pre-Trump Republican Party that turned opposition to it into a cause. He adopted it as the major initiative of his first year in office mainly because he hadn’t worked out any other agenda. Repeal failed in part because the new voters he brought to the party were not enthusiastic about cutting government. Trump understands where they’re coming from enough to say he won’t touch Social Security and Medicare. But the lesson he draws with respect to the legacies of Franklin D. Roosevelt and Lyndon B. Johnson, he won’t extend to that of Barack Obama.
Follow this authorRamesh Ponnuru's opinionsFollow
What makes Trump’s latest move on health care even stranger is that in the past he has come closer to a stronger message about it. Trump has said that he already repealed Obamacare. That’s false, of course. But what’s true is that Obamacare has changed a lot since it was first enacted, partly because of Trump.
The Supreme Court started the revisions, ruling in 2012 that the federal government had to reduce the pressure on states to expand Medicaid. Ten states are still opting out. In 2017, as part of a tax bill, Republicans eliminated Obamacare’s least popular feature: its fine on people without health insurance, known as “the individual mandate.” That’s what Trump was talking about when he said he had repealed the whole law. The next year, a bipartisan deal got rid of another feature of the law: the Independent Payment Advisory Board, which critics had attacked as a kind of centralized rationing of health care. Trump signed that repeal, too.
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From the start, Republicans also hated Obamacare’s tax increases. The biggest tax, on income and investment returns for high earners, survived. But the tax increases that generated the most anger were shelved. Bipartisan votes ditched the tax on medical devices and the tax on the most expensive employer-provided health plans.
The insurance exchanges that Obamacare set up are still intact, but they are having less impact than originally expected. In 2012, the Congressional Budget Office projected that, 10 years later, 20 million people would get insurance through those exchanges. It looks like the actual number this year will be 15 million. And even that level required the Trump and Biden administrations to ramp up subsidies for participating in the exchanges. When the added money expires, enrollment is expected to drop.
I still think Obamacare was a wrong turn for health policy. There were cheaper, less government-heavy ways to make insurance coverage more accessible. But by now, 13 years after Obama signed his health-care policies into law, and after multiple important revisions to them, considering Obamacare in isolation from the rest of the health-care system makes no sense. It will make even less sense in 2025, when Trump will take office again if he wins the election.
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Which is not to deny that the system needs reforms. Greater use of competitive bidding in Medicare would generate savings for the program and its beneficiaries alike. Health savings accounts, which Congress created in 2003, ought to be updated and expanded. Neither of these changes has much to do with Obamacare. Packaging these policies, or any others, as “Obamacare repeal” will not make them more viable — or more helpful to Trump in the elections.
One begins to suspect that Trump and his advisers are not “seriously looking” at health-care policy. My guess is that we will not see a detailed alternative plan from them before the next election. The idea that he intends to repeal Obamacare will, however, live on, if only in Democratic ads.
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The Biden campaign can hardly believe its good fortune. Not only do Republicans appear likely to nominate a presidential candidate Biden has beaten before, but that candidate, Donald Trump, has chosen to revive an issue that would be likely to help Biden in a general election.
That issue is Obamacare. For years, railing against it helped Republicans. Then they took power and tried to repeal it, at which point voters began to focus on specific health-care benefits they valued. The polling turned ugly, and Republicans could not reach a consensus on how to replace Obamacare. A 2017 no vote from Sen. John McCain (R-Ariz.) dealt a killing blow to the effort, and Republicans haven’t raised it again since.
Until now. Trump recently said he is “seriously looking at alternatives” and still wanted to “terminate” the program. The Biden campaign responded that what Trump really wants to terminate are the health-care plans of millions of people, particularly those with chronic illnesses.
Trump didn’t have to make Obamacare an issue again. It was the pre-Trump Republican Party that turned opposition to it into a cause. He adopted it as the major initiative of his first year in office mainly because he hadn’t worked out any other agenda. Repeal failed in part because the new voters he brought to the party were not enthusiastic about cutting government. Trump understands where they’re coming from enough to say he won’t touch Social Security and Medicare. But the lesson he draws with respect to the legacies of Franklin D. Roosevelt and Lyndon B. Johnson, he won’t extend to that of Barack Obama.
What makes Trump’s latest move on health care even stranger is that in the past he has come closer to a stronger message about it. Trump has said that he already repealed Obamacare. That’s false, of course. But what’s true is that Obamacare has changed a lot since it was first enacted, partly because of Trump.
The Supreme Court started the revisions, ruling in 2012 that the federal government had to reduce the pressure on states to expand Medicaid. Ten states are still opting out. In 2017, as part of a tax bill, Republicans eliminated Obamacare’s least popular feature: its fine on people without health insurance, known as “the individual mandate.” That’s what Trump was talking about when he said he had repealed the whole law. The next year, a bipartisan deal got rid of another feature of the law: the Independent Payment Advisory Board, which critics had attacked as a kind of centralized rationing of health care. Trump signed that repeal, too.
From the start, Republicans also hated Obamacare’s tax increases. The biggest tax, on income and investment returns for high earners, survived. But the tax increases that generated the most anger were shelved. Bipartisan votes ditched the tax on medical devices and the tax on the most expensive employer-provided health plans.
The insurance exchanges that Obamacare set up are still intact, but they are having less impact than originally expected. In 2012, the Congressional Budget Office projected that, 10 years later, 20 million people would get insurance through those exchanges. It looks like the actual number this year will be 15 million. And even that level required the Trump and Biden administrations to ramp up subsidies for participating in the exchanges. When the added money expires, enrollment is expected to drop.
I still think Obamacare was a wrong turn for health policy. There were cheaper, less government-heavy ways to make insurance coverage more accessible. But by now, 13 years after Obama signed his health-care policies into law, and after multiple important revisions to them, considering Obamacare in isolation from the rest of the health-care system makes no sense. It will make even less sense in 2025, when Trump will take office again if he wins the election.
Which is not to deny that the system needs reforms. Greater use of competitive bidding in Medicare would generate savings for the program and its beneficiaries alike. Health savings accounts, which Congress created in 2003, ought to be updated and expanded. Neither of these changes has much to do with Obamacare. Packaging these policies, or any others, as “Obamacare repeal” will not make them more viable — or more helpful to Trump in the elections.
One begins to suspect that Trump and his advisers are not “seriously looking” at health-care policy. My guess is that we will not see a detailed alternative plan from them before the next election. The idea that he intends to repeal Obamacare will, however, live on, if only in Democratic ads.
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