The Washington PostDemocracy Dies in Darkness

Opinion What does Donald Trump really think about health care?

(AP Photo/Evan Vucci)
Placeholder while article actions load

The other day, Kellyanne Conway said something that could come back to haunt Republicans later. Asked by Joe Scarborough whether all of the people currently benefiting from Obamacare “will have health care under whatever replaces it,” Conway replied:

“Yes. That is correct. We don’t want anyone who currently has insurance to not have insurance.”

Conway seemed to commit Trump to supporting only a replacement plan that covers just as many people as the Affordable Care Act currently does. This puts Trump at odds with many Republicans, who are opposed to the taxes, spending, and regulations that are necessary to make Obamacare’s large coverage expansion possible.

Which prompts a good question from Ezra Klein: When you get past all of Trump’s bluster and noise about what a disaster Obamacare is, what does he actually think about health care reform?

We know he wants to repeal Obamacare. But why does he want to repeal it? And how much of a political price is he willing to pay to repeal it?…
In the past, Trump praised Canada’s single-payer system. In an interview with 60 Minutes, he said he believe that “everybody’s got to be covered” and under Trumpcare, “the government’s gonna pay for it.”…
Trump might think Obamacare is bad mainly because it’s unpopular, and because people at his rallies cheer when he says it’s bad. And if that’s the case, he is not going to want to replace it with something that’s less popular, that leaves fewer people uninsured, and that creates nationwide chaos that he gets blamed for. But that’s going to put him at odds with Republicans who want to roll back the law for ideological reasons, and who are willing to pay the price.

One of the big looming questions right is: Where does Trump actually stand on health reform generally, and on repeal and replace in particular? Here’s a stab at answering.

President Obama and Vice President-elect Mike Pence each meet with lawmakers from their parties, Jan. 4, to discuss plans for the Affordable Care Act. (Video: Sarah Parnass/The Washington Post, Photo: Matt McClain/The Washington Post)

This has mostly been forgotten, but Trump recently declared with no equivocation in that 60 Minutes post-election interview that Obamacare will be repealed and replaced “simultaneously.” That puts him at odds with congressional Republicans forging ahead with a repeal-and-delay strategy, which would repeal the ACA with no certainty at all that there ever will be any replacement from Congress. (Even if Republicans keep saying there will be a “bridge” to this replacement, it could very well prove a Bridge to Nowhere.)

This doesn’t necessarily mean Trump won’t sign a repeal-and-delay-with-no-guaranteed-replacement bill. He may. But it still hints at where he currently stands: in that same post-election interview, Trump also declared that “we’re going to repeal it and replace it,” and “we’re not going to have a two-year period where there’s nothing.” He seems to envision a smooth transition in which no one loses health care. Just as Kellyanne Conway suggested.

There is no indication Trump has thought deeply about how this might be done. But it seems obvious that he thinks that if we want to do this, it shouldn’t be all that hard to do. He doesn’t see ideological constraints. As Klein notes, Trump sees no particular reason why government should not play a key role in making it happen. During the campaign Trump repeatedly signaled that he is ideologically different from most Republicans on core questions involving the proper scope and ambition of government action to expand health care to poor and sick people.

Follow Greg Sargent's opinionsFollow

Yes, it’s very possible this posture was just a big scam. But I keep thinking about one particular moment during the campaign, in which he contradicted himself in spectacular, widely-mocked fashion. At an event at his resort in Florida, Trump gestured to a crowd of his workers, and said: “All of my employees are having a tremendous problem with Obamacare.” Then he immediately contradicted this by saying his company provides them with insurance: “This is what jobs do. Jobs just make lives and they make people and they make families and they’re not worried about their health care because we take great care of people.”

Trump didn’t know how Obamacare works. He just knew he’s supposed to tell people it is a disaster for them, and the people nearest to him happened to be his employees. But it was a telling moment in a deeper sense. Trump thinks everyone should be taken care of, and that means having the financial security that health insurance brings. He thinks it’s preferable for them to have insurance through their jobs — that everyone should have great jobs, that companies should “take great care of people.” As for those who don’t have jobs, or can’t get coverage through their work, it should be easy to figure out a way to give them insurance, too — “terrific” insurance, in fact. “I know how to do this stuff,” Trump says. He likely thinks it’s crazy that any Americans should go without health care in the “great” country he’s promised, and that fixing this won’t be that hard, once he puts his mind to it. He’ll shower everyone with jobs and bring in government where necessary. Easy! (Of course, this assumes he’ll take a magnanimous view of the millions of Americans who didn’t support him, which is hardly assured.)

The rub is that even in this optimistic reading, there is cause for pessimism. Even if if Trump does think this, he likely does so only when he thinks about the question at all. This isn’t something he seems to care much about. If he does end up wanting to keep everyone on Obamacare covered, we still don’t know how much he’ll want to do it. He would have to bulldoze congressional Republicans into it, which would require spending lots of political capital. It’s far more likely that he’d just discard his conviction. Or that he’d allow himself to be persuaded by the buzzwords of clever congressional Republicans who tell him their plan provides “access” to coverage for just as many people, or something like that. Or that he’d just make a deal with them. So even if Trump isn’t ideologically in sync with Republicans on these questions, there isn’t great cause for optimism.

Unless Trump really, really hates being seen as the guy who tossed millions off insurance. Which is at least a possibility.