THE MORNING PLUM:
In recent days, Donald Trump and his advisers have gone to tremendous, extraordinary, terrific lengths to obscure a basic aspect of the replacement for the Affordable Care Act that he and congressional Republicans are likely to embrace after repeal: It will cover far fewer people.
Today, Democrats have a chance to expose this in new detail, when they question Tom Price, Trump’s pick for health and human services secretary, at his hearing before the Senate health and education committee.
Trump and his advisers have been saying that no one who currently has coverage under Obamacare will lose it under the GOP replacement. Trump himself recently said that under his replacement, “everybody” will have insurance, adding that “there was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Top transition adviser Kellyanne Conway recently made similarly nice-sounding noises.
But today, Trump seemed to backtrack on this promise in interviews with Fox News and Axios. While he reiterated that people without money will get coverage, he clarified that he’s considering a mechanism to do this: Medicaid block grants. “We’ll probably have block grants of Medicaid back into the states,” Trump told Fox.
Progressives tend to oppose Medicaid block grants because they are all but certain to get cut, and because states would restrict eligibility requirements. As the Center on Budget and Policy Priorities recently put it, they “would likely eliminate the guarantee that everyone who’s eligible and applies for its benefits would receive them.”
Thus, this idea — which seems likely to be at the center of the Trump/GOP replacement plan — would dilute the guarantee of coverage that Obamacare is striving to make universal. The ACA does this through a combination of expanded Medicaid for everyone who is eligible (in states that participate) and subsidies that are doled out according to means to cap the percentage of income that other people pay for coverage. The GOP replacement would come up with a new subsidy scheme, perhaps tied to age but not income, but there’s no indication yet that it would accomplish that cap. That, combined with the likely Medicaid cuts, would add up to a scrapped guarantee.
Thus, the question of what the Trump/GOP replacement will actually look like turns on the question of what really counts as everybody having insurance. If the Republican plan does not strive for this type of guarantee but does try to make insurance more affordable, Republicans might still say this constitutes giving people access to insurance (if they’re willing to pay for it).
Today, Democrats have a chance to pin down Price on this. Harold Pollack, a health policy expert at the University of Chicago, suggests questions designed to clarify not just whether Trump envisions a replacement that covers “everybody,” but what this actually means:
“Should every American who has an income below the federal poverty line be guaranteed access to Medicaid? Should every other American be entitled to health insurance with out-of-pocket and premium costs limited to an affordable, capped fraction of their income?”
Then there’s also the question of what constitutes acceptable coverage. The ACA has basic regulatory standards that Republicans are going to want to repeal. That, too, is an area on which Price should be questioned.
“The real question is what counts as insurance,” Nicholas Bagley, a University of Michigan law professor who has written extensively on health reform, says. “Does Price support a replacement that would allow insurers to exclude mental-health services? Preventive services? What about annual or lifetime coverage limits? Or $10,000 deductibles?”
Now, for various reasons, Republicans just don’t believe health reform should guarantee coverage in the manner that the ACA does. And that’s fine — that’s their philosophical view. But the point is that Trump and his advisers are trying to obscure this. Trump does not want to be the guy who kicked millions off insurance. But it appears congressional Republicans philosophically cannot support anything that does not do this. This basic problem cannot be spun away forever. An actual comparison between the ACA and the GOP replacement cannot be dodged in perpetuity. Hopefully, today will begin to supply some clarity.
* ANOTHER POLL FINDS TRUMP APPROVAL IN TOILET: The latest comes courtesy of CBS News:
More Americans disapprove (48 percent) than approve (37 percent) of the way he has handled his presidential transition….Trump’s favorable rating (32 percent) is the lowest of any president-elect in CBS News polling going back to Ronald Reagan in 1981.
This comes after new Post and CNN polls put Trump at 40 percent. #FakePolls
* TRUMP ADVISERS DISMISS HIS ABYSMAL NUMBERS: The New York Times reports that Trump advisers are dismissing his awful numbers this way:
Mr. Trump’s advisers said privately that his unexpected rise to power showed that such traditional barometers did not matter as much anymore. If polls were to be believed, he would not have been president, they said.
Of course, if Trump remains in the toilet, congressional Republicans may not agree. The key is whether that complicates his ability to move his agenda.
* OBAMA’S APPROVAL RISES AGAIN: A new CNN poll finds that Obama’s approval rating has hit 60 percent, the highest since June of 2009:
Compared with other outgoing presidents, Obama lands near the top of the list, outranked only by Bill Clinton’s 66% in January 2001 and Ronald Reagan’s 64% in January 1989. About two-thirds (65%) say Obama’s presidency was a success.
Now the public will be treated to a contrast between the Trump and Obama presidencies.
* AMERICANS NOW SEE A GOOD ECONOMY: A new Post-ABC News poll also finds Obama’s approval rating at 60 percent. And:
In the last few years, the share of Americans with positive ratings of the economy has more than doubled to 51 percent in this month’s survey, their highest level tracked by Post-ABC polls during his tenure….the share of people saying the economy is poor has dropped from 62 percent in early 2009 to 14 percent today.
Thanks, President-elect Trump! (The reality is that Trump inherits this positive economic sentiment.)
* WHY YOU SHOULD WORRY ABOUT TRUMP ON FOREIGN POLICY: Top Obama foreign policy adviser Ben Rhodes tells Politico that Trump’s control of nukes is hardly the only thing to worry about:
“What concerns me is the things that happen every week. I don’t think people realize how many decisions the president of the United States makes about military action. The Iranians harass some vessel of ours in the Persian Gulf: What do we do in response?…The Chinese pass too close for comfort by a U.S. Navy ship in the South China Sea. … a dust-up with the Iranians or the Chinese could get out of hand very fast.”
It’s doubly reassuring that Trump could very well be tweeting amid these crises at 4 in the morning.
* TRUMP’S INAUGURATION MAY SET A RECORD: With dozens of House Dems set to boycott the festivities on Friday, McClatchy notes that such boycotts have happened before. But the Senate historical office has “no record of a boycott comparable to that being proposed for Trump’s inauguration.”
It’s yet another way in which Trump is making history.
* AND HERE’S HOW TRUMP’S GAME ON ‘SAVED’ JOBS WORKS: Trump tweeted angrily this morning about NBC News’ failure to give him sufficient credit for recent announcements of “saved” jobs”:
Totally biased @NBCNews went out of its way to say that the big announcement from Ford, G.M., Lockheed & others that jobs are coming back…
— Donald J. Trump (@realDonaldTrump) January 18, 2017
to the U.S., but had nothing to do with TRUMP, is more FAKE NEWS. Ask top CEO's of those companies for real facts. Came back because of me!
— Donald J. Trump (@realDonaldTrump) January 18, 2017
Note that Trump is basically calling on CEOs to prop up his self-serving version of events, which of course they have a huge incentive to do.