Resisting Trump’s Strategic Health Care Shifts

Resisting Trump’s Strategic Health Care Shifts

By J.D. Munch

As is the case with many of his policy positions, Donald Trump has presented a multitude of statements on his health care plans. Many, if not all, are entirely unmoored from reality, and rest instead on what he found politically advantageous in the moment he was speaking or tweeting. Nonetheless, identifying the positions he has taken can provide useful in our ongoing efforts to resist Trump’s push for more power. We should not isolate moments and take him at his word at any given time; he has definitively proven himself untrustworthy, and in fact excoriates media members who quote his words and attempt to assign meaning to them. Rather, we need to look to the strategies behind his statements, and be prepared to identify, reveal, and resist them.

Won’t Touch Medicare or Medicaid

In 2015, then-candidate Trump went on record saying, “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.” He certainly planned to “repeal and replace” the Affordable Care Act, but he was going to leave those programs alone. His explanation was simply that he knew where the money was to maintain those programs.

As is abundantly clear, Trump spoke not from a position of having a really good brain or really any understanding of how his great new health care plan might work, but rather from a position of wanting to run a populist campaign. He knew his blue collar voting base relies on those programs. So, with no details or facts, he simply declared he would maintain those programs. The proposal his administration now supports even has a section called a “Medicaid Enhancement”! Of course, that “enhancement” actually takes back the Medicaid expansion that the Affordable Care Act currently provides, thus cutting Medicaid in all of the 31 states that accepted the expansion. Thus, if Trump gets his bill enacted, Medicaid will be cut.

Everyone Will Have Health Insurance

In both 2015 and this past January, Trump declared that his plan would provide coverage for everyone. He infuriated many Republicans with the statement; after all, actually providing health care for everyone in the country goes against every fiber in a survival of the richest neoconservative’s being. The logic is straightforward:

  1. Socialism is bad.
  2. The government helping people take care of themselves is Socialism.
  3. Universal health care is the government helping people take care of themselves.
  4. Therefore, universal healthcare is bad.

Were Trump to be true to his word, he would be creating a Very Bad Thing.

Of course, Trump tends not to be true to his word. Rather than subsidizing insurance premiums as the ACA does, Trumpcare would provide tax credits in their place, credits that would come nowhere near paying for people’s insurance needs. As a result, the Congressional Budget Office has estimated that Trump’s health care plan, if enacted, would result in 14 million currently insured people losing their coverage in 2018, and 24 million losing their coverage by 2026.

Coverage vs. Access to Coverage

At various times, Trump has waffled between claiming everyone will have health coverage, on the one hand, and everyone will have access to health coverage on the other. These sound similar, but Trump’s using them interchangeably depending on whom he spoke with last should let everyone know the importance of resisting Trump’s rhetoric on this issue.

The health plan put forth provides a prime example of the difference between the two. It provides for greater use of Health Savings Accounts, essentially a tax shelter for the wealthy. An HSA gives people the ability to save money tax-free, which they can later use to pay for their medical costs. So great news to all of the poor and working-class citizens living paycheck to paycheck: you can now save all of that extra money you don’t have and pay for your own healthcare without the government interfering! And for those who don’t believe in themselves enough to make magic money accumulate and can’t afford insurance premiums either can get tax credits to refund a small portion of the policies they couldn’t afford to buy.

This is the myth of universal access to health insurance. It depends on the story to which far too many conservatives cling: that if people can’t afford basic care, it is because they have chosen to be in their position. It represents a pleasantly simple world, one in which everyone is equal and choices we make determine our levels of wealth and success, and anyone who does not reach the pinnacles of monetary success has chosen to fail. We want to believe we control our lives, and admitting that not everyone can do so would ruin that nice way of seeing the world.

Unfortunately, the world is a complicating and sometimes frustrating place. And in a capitalistic society, having winners always means having losers as well. If the end product is universal access rather than universal coverage, many who currently have insurance will necessarily go without.

No One Knew!

In a moment that can only be seen as a clumsy attempt to reset expectations, Trump made an astounding statement in February of 2017: “Nobody knew that health care could be so complicated.” All of his campaign style comments about how he knew how to fix it dissipated, left with this statement. So we must ask: why would he suddenly confess a limitation on his ability? Do we see this as a moment of humility in which President Trump accepts reality and approaches a difficult issue with nuance and tact?

HAHAHAHAHAHAHA… Um, no. Trump has begun to see the potential that he may fail, and his response is twofold. First, he is attacking the Affordable Care Act with even more vigor than he did during his campaign. He calls it a failure, a disaster that is spiraling out of control. None of this comports with the facts or acknowledges the good done by the act, but reality has never stopped Trump before. If he cannot create a plan that will be good on its own, he falls back to his usual approach of demonizing the other side so much that his supporters are frothing at the mouth for any alternative, however disgusting.

Second, but related, he has presented an alternative: blame the Democrats. He has already issued an executive order not to enforce penalties for the insurance mandate, a critical element to controlling costs under the ACA. By chipping away at other pieces, and by creating continued uncertainty for the insurers that participate in the exchanges, he can create an environment in which only some of the parts function, and the insurance market does in fact spin out of control. Meanwhile, he can continue his explosive rhetoric against the ACA, working his crowd without doing anything but undermine the law. Destroy from within, and then step over the ashes.

In both of these scenarios, we see the essence of Trump emerge, an essence we must continue to resist. He spews bombast and vitriol, lambastes his opponents with blatant lies and misleading innuendoes. He never actually creates something, never delivers on his “Vote for Pedro” campaign promises, but as long as he can succeed in keeping others pressed down under him, he will remain on top—no matter how low he sinks.

How the Resistance can Fight Back

In some senses, the resistance lacks power. Democrats do not control Congress or the White House, and the courts represent a tenuous path for fighting against bad legislation. But Trump’s own propensity for lying will eventually come back. He has failed on his most appalling immigration reforms, and his revised Muslim ban looks destined to fail again. His populist promises look to be fading as well; he made promises on which he cannot deliver, and the lost coverage will resonate with his voters: the very people who will hurt the most. He has carved out United States dollars to pay for his border wall, and Mexico has no intention of ever paying for it.

In short, every promise he made is failing. People who could be fooled by the glitz of his campaign will eventually see that he cannot bulldoze those he claimed he could. The more we resist, and implore the Congressional leaders who actually give a damn about their constituents to join, the less damage Trump can do. Several Republican Senators have pushed back against the worst of Trump’s policy proposals and cabinet appointments, joining what remains a united Democratic front. Trump has already reached a point that his most awful attributes cross party lines.

That said, resisting Trump as we go forward will require more than prodding current Senators and Representatives. We need to continue pointing out his lies and inconsistencies, and push back against those who do not fight him. A power change at the midterm elections can further reduce Trump’s leverage and curtail his power grab. The health care battle presents an opportunity to take him on and push him back. We must not squander it.