On Sunday, Health and Human Services Secretary Tom Price made a remarkable statement about the Trumpcare bill now under consideration in the Senate: he said it would increase the number of people covered by health insurance. Here was Price’s explanation:
One of the interesting things that is in this bill that wasn’t in previous iterations is the opportunity to make sure that those folks that actually fell into a gap below 100 percent of the poverty level, but above where a state might allow individuals on the Medicaid system. This bill provides for coverage for those individuals through the tax credit process, and that’s something that’s new. That’s also one of the reasons we believe we’re going to cover more individuals than are currently covered. The goal is to get every single American covered and have access to the kind of coverage they want.
As health policy expert Avik Roy has noted, Price is correct that the current Senate bill fills a hole the House version of the same bill did not — it creates subsidies for people who aren’t in poverty but also can’t afford health insurance. But the notion that the bill will result in an increased number of people covered, either through private insurance or Medicaid, is rather ridiculous. What’s more, it’s a foolish goal.
And herein lies the problem for the Republicans: they’ve accepted the Democratic metric on health care success. They now believe that the mark of a good piece of legislation is the increase in number of insured, rather than increase in personal freedom in choosing insurance options. That means they are bound to restrict insurance choice, since it is far easier to achieve “full coverage” through regulation and subsidies than it is through allowing people to choose whether to be covered, particularly young and healthy people.
This central conflict has undermined any attempt to repeal and replace Obamacare. As Rand Paul correctly notes, “I think the longer the bill’s out there, the more conservative Republicans are going to discover that it’s not (a) repeal. And the more … everybody’s going to discover that it keeps the fundamental flaw of Obamacare.”
In the short term political calculus, Republicans cannot afford to leave Obamacare in place. Not only would they be widely perceived as having broken their promise to the American people, they’d undercut their own ability to pass tax reform, essentially destroying their legislative agenda for President Trump’s first Congressional term. But in the long term, any non-repeal of Obamacare that enshrines number of insured as the central goal will result in catastrophe for the Republicans: they’ll own the same failing system Democrats now own. The Democrats will claim that the free market has failed, and they’ll push for single-payer. This is the situation into which Republicans have placed themselves by lying about repealing Obamacare, but agreeing with its basic principles.