Dem
51
GOP
49
Last week, Donald Trump went off on a rant, declaring that "Obamacare sucks" and that he would replace it with something better. Despite being asked many times what he would replace it with, Trump has failed to even come up with a proposal.
At least former Speaker Paul Ryan had a plan for Ryancare. He would allow insurance companies to reject sick people. This would result in something like 80% of the population being on private insurance. Since they were all healthy, premiums would go down due to competition. These happy people would all vote Republican, according to his plan. The other 20% would be allowed to enroll in a government health program funded by an annual appropriation from Congress. The catch? If the money ran out in August, no claims submitted in September-December would be paid. Sorry, try next year or write your congressman a letter asking for more money next year. Tip: Get sick in January, before the money runs out. Ryan never got anywhere with this. Trump has never even hinted what his plan would be.
It probably doesn't matter what Trump might propose. Forty million people now have health insurance through the ACA. Nine states (Idaho, Maine, Missouri, Nebraska, North Carolina, Oklahoma, South Dakota, Utah, and Virginia), with 15 Republican senators, have expanded Medicaid since 2017, the last time a vote to repeal the ACA was taken. Benedic Ippolito, a health-care specialist at the conservative American Enterprise Institute, said: "No matter how much Republicans dislike Obamacare, they're unlikely to jeopardize the massive federal Medicaid funding their states now receive. The money is just so powerful at the state level." In other words, it would be nearly impossible for Trump to repeal the ACA because most Republican senators (and all Democratic senators) would now vote against repeal. This reality makes Trump's promise to repeal the ACA very bad politics because so many high-ranking members of his own party oppose the idea.
Sen. Mitt Romney said he doesn't see "any impetus for reform efforts at all." Sen. Bill Cassidy (R-LA)—who played a key role in the 2017 repeal attempt—said of Trump: "Does he have a policy initiative that he is going to put forward? Or is it just a stream of consciousness musing?" A few Republican senators might be willing to tinker around the edges and make small adjustments to the ACA. Sen. Mike Rounds (R-SD) said: "If we had the time and we focused on it, I think we could do a better job than what Obamacare does in terms of providing choice and price." That doesn't sound like: "Rip it out, root and branch, right now."
If Trump is foolish enough to continue saying that he wants Obamacare repealed, it is probably going to cost him some votes from those 40 million people who have an ACA policy. Some of them are now insured for the first time and aren't keen on losing their insurance unless Trump is a bit more specific about what he will replace it with. Trump's advisers will no doubt tell him over and over just to forget the whole thing, but since he is obsessed with getting rid of Barack Obama's main achievement as president, he might not listen. The more he talks about it, the more ads Team Biden will be able to make opposing him. And these are easy ads to make. Just find a few people with seriously sick children or parents who are now finally getting medical care as a result of the ACA and you have the makings of a real tearjerker. No need to show charts with statistics about who is insured vs. 2008. Trump's comment is what in sports is called an "unforced error." (V)