During a news conference Wednesday, White House press secretary Sean Spicer was asked how an amendment to the American Health Care Act that could increase premiums for those with preexisting conditions squares with the president’s pledge that this wouldn’t happen.

His response? Something we could have expected from this administration.

White House press secretary Sean Spicer said it would be "impossible" to calculate the potential cost of insurance plans for people with preexisting conditions who would be forced to buy insurance from state-run high-risk pools under the new GOP health care bill, on May 3 at the White House. (Reuters)

REPORTER: An analysis from AARP showed that the sickest patients will pay nearly $26,000 a year in premiums under the new health-care law and that $8 billion which was included in that amendment this morning is not nearly enough to lower those costs.

So I’m wondering, how does that, which would be a major premium hike on the sickest patients, square with the president’s promise to both lower premiums and take care of those with preexisting conditions?

SPICER: So it sounds interesting to me that, without — there are so many variables that are unknown, that to make an analysis of that level of precision, it seems almost impossible.

Let me give you an example. So right now preexisting conditions are covered in the bill. They always have been; we’ve talked about that before. States have a right to receive a waiver. If someone has continuous coverage, that’s never going to be an issue, regardless of — no circumstance does anyone with continuous coverage would ever have a problem with preexisting.

If someone chose not to have coverage for 63 days or more, and they were in a state that opted out, and they had a preexisting condition, and they were put into a high-risk pool — then we’ve allocated an additional $8 billion over five years to help drive down those costs.

So for someone to know how many people that is, what number of states are going to ask for and receive a waiver is literally impossible at this point. So to do an analysis of any level of factual basis would be literally not a [possibility].

That right there is a natural end point of the Donald Trump phenomenon: A representative of the administration declaring that there is no knowable truth behind the debate over a policy, so the policy might just as well be supported.

It is true that it is literally impossible to know exactly how many people with preexisting conditions will live in states that ask for a waiver on their coverage and to know how much that will cost. It is similarly impossible to know precisely how many Americans do any number of things. How many Americans like President Trump? How many Americans have jobs? How many Americans are Hispanic? Measuring each of these things offers a level of imprecision, but that doesn’t mean that we can’t know generally what those numbers look like.

As explained by the reporter, the estimate about those with preexisting conditions — that is, serious health issues that existed before receiving insurance coverage — comes from AARP. Here’s the relevant excerpt from an April 27 article:

States that want to allow insurers to charge more for people with preexisting conditions would have to have a high-risk pool program or a reinsurance program. For consumers who buy coverage in a high-risk pool, AARP’s PPI projects that the premiums could reach $25,700 a year in 2019, when this provision would go into effect.

That figure would disproportionately affect those ages 50 to 64, since AARP estimates that 40 percent of Americans in that age bracket have such conditions. What’s more, the density of the population with such conditions is higher in Appalachia and the South, areas that are more conservative and therefore more likely to ask for some sort of waiver from the stipulations in place.


As Spicer notes, the $25,700 would be paid only by those who had let their coverage lapse. How many that may be isn’t known. But $8 billion spread over five years would cover $25,700 in premiums for fewer than 63,000 people a year.

AARP estimates that 24.8 million Americans have preexisting conditions, just within that 50-64 age range. The Kaiser Family Foundation figures that 52 million in total have such a condition.

So the question is valid: How does that square with the president’s promise to both lower premiums and take care of those with preexisting conditions? We don’t know a hard number for those who will be affected, no. But we know that some large number is likely to be.

Over the course of the 2016 campaign, Trump used one rhetorical trick repeatedly. Questioned about an issue, he’d gin up some anecdotal example providing an opposing line of thinking and use that to sort of shrug the whole thing off. Trump says his phones were wiretapped at Trump Tower and, look, the New York Times says that someone associated with his campaign was surveilled in some way, so that basically proves the point. Remember when he sat down with Bill O’Reilly and said explicitly to “forget all that” about not having actual data, pointing instead to a report that had nothing to do with voter fraud?

This is an actual strategy: Cast doubt about the certainty of an issue and use that doubt to press forward as you see fit.

In this case, there’s a direct political advantage. When a Congressional Budget Office analysis of the original iteration of the AHCA came out in March showing that 24 million fewer people would be insured in a decade, it spurred a number of Republicans to bail on the legislation. Spicer’s “who knows” strategy isn’t just meant to rebut reporters, it’s meant to keep House Republicans in line until they vote.

Spicer is right that we don’t know precisely how many people will be negatively affected by the updated American Health Care Act. In fact, it’s probably safer to assume that the uncertainty in how many people will be negatively affected will work against the administration, given how many people have preexisting conditions. Regardless, the exact number isn’t the point. The point is that we know that some will be, and we know that Trump said that wouldn’t happen, which is why the question came up.

For that, Spicer had no answer.