Repeal & replace Obamacare, Donald Trump's first success?

Although I myself am quite to the left, I have always thought the Trump panic on the American Left is way overdone. Trump Derangement Syndrome. Although his cabinet picks are a disappointment, the man himself is clearly not very conservative. Good policy can also happen in spite of his presidency. But now I am starting to see an actual, possible good thing resulting from his reign.

Obamacare replacement.

Now to make it clear, I am not an ACA supporter myself. I think it’s a horrible, right-wing monstrosity. Like any good Kenyan Muslim Communist my own preference for UHC is proper, government-run healthcare. High taxes, government bureaucrats, death panels, the works. But that’s not America. America itself being a such a right-wing mon… uh… country, I imagine the something like the ACA should actually be a good fit. Working properly, it does hit the important cornerstone features of any UHC policy.

Alas, it is not working properly. By reports, the fundamental failure has turned out to be not enough healty people paying for sick people. One of the big UHC cornerstones. The mandate didn’t work well enough.

Now, enter Trump and the Republican health care plan (PDF link here.)

I’m looking for just one thing: getting healthy people to pay for sick people.

I can actually see the Republican plan pulling this off. Effectively, giving every person $5000 or $7000 practically cash on the barrel, as long as they go out and get a health insurance plan. Surely that must be a powerful incentive.

It is not even important what else the plan will change. The ACA is already a right wing monstrosity (albeit hitting the most important UHC pillars). As long as the new plan manages to keep the important pillars in place in some form or other, it’s all good.

I have long thought that the only thing Republicans need to change to make Obamacare repeal a roaring success is change the name. That was basically the Kynect experience. Now this one actual, true failure has cropped up, and their plan has in fact the potential to fix that.

And think about the propaganda victory. So far, Trump has been exceedingly good at getting propaganda successes, while his opposition has been a notable failure (propaganda-wise and otherwise). Now we see Trump fulfilling his big promise of repealing Obamacare; giving every person $5000 in cash (perception is reality); and getting better and cheaper health care plans to choose from (thanks to more healthy people paying)!

A stunning success for Trump and for the Republicans.

A total failure of the Trump opposition.


First of all, I have a hard time supporting any legislation that begins with outright lies in its very rationale. Why would I believe it will accomplish its goals when it cannot accurately define the problem(s) it purports to solve?

The PPACA is a 900+ page document with lots and lots of details. On the page you linked, I saw some vague goals, but not a lot of details about how this would actually work. I would like to see that much more fleshed out before I can say that it is a good idea.

The biggest problem I see the Republicans having (and continue to have) is that the PPACA is THEIR PLAN. They have had a difficult time railing against it when it was the plan they proposed to counter Hillary Clinton’s proposal back in the mid-1990’s. They even had a Republican governor (and future candidate for President) give it a try in his state, and, much to everyone’s surprise, it actually sort of worked. They have to simultaneously say that they were wrong thirty years ago, wrong in Massachusetts, but right today. That’s not impossible to pull off, but they’ve found it pretty challenging.

Are they proposing giving every man, woman, and child $5000? Because I live in an area where healthcare rates are relatively affordable compared to other parts of the country, and the average bronze-level plan has annual premiums of over $14,000 for a family of four - and then there is the deductibles, which are thousands of dollars more.

Under the ACA, those premiums are hugely subsidized for most enrollees, but under the plan you describe I don’t see how they are affordable for the typical family unless you are giving $20,000 to a family of four.

Man, that sounds like a great deal! Where’s all the money for that cash coming from?

Oh wait, deduction, not credit. Given a 6% marginal federal income tax rate, it saves me click click click 450 dollars. That’s a lot less than 5 grand, if I learned mathematical comparisons correctly. Either way, it has to be paid for, and the bill itself refuses to follow PAYGO, even though it would alter revenues.

Does it accomplish “healthy people paying for sick people?” Maybe. It mentions “qualified health plans” with no real qualifications, which would lead to the exact kind of useless low premium, skyrocketed deductible plans that were discontinued under PPACA, a.k.a. “the plan you couldn’t keep.” That’s healthy people paying diddly for a plan that’s worth diddly, just to get a fat deduction from the gubmint. So healthy people are slightly subsidizing the sick people, and the premiums for real plans just keep going up.

Trash bill is trash.

On a side note, are all written bills so fucking garbled? “Here’s the bill” followed by 20 pages of “But change this word to that word, add this qualifier to that section, parts a, b, and Zeria, and move THIS period one space to the right.” It’s as if they don’t want anyone to actually understand it.

They’ll repaint it, rotate the tires, and call it Trumpcare. Folks will eat it up.

I’m skeptical. The plan strikes me as largely more of the same, fiddling with health insurance markets in an attempt to drive down the cost of health care overall. “If we make health insurance companies compete for your business, the insurance companies, in turn, will try to aggressively negotiate with health care providers so that the insurance companies can offer lower premiums to entice customers.” Didn’t seem to work all that well with the ACA marketplaces, flawed as they are.

As far as the “getting healthy people to pay for sick people”, there’s no mandate that I see. If you don’t buy health insurance, you simply don’t get the tax break. It reauthorizes states to run their own high-risk-pool programs, but that’s about it.

Making Medicare payment data public is a potentially interesting change. Whether insurance companies will be able to successfully leverage that data to negotiate lower payments to providers is an open question, but at least it’s an idea.

There’s also a section about making it more difficult for patients to successfully sue medical providers, as a way to drive down costs. Again, debatable whether this will be effective or beneficial, but at least it’s an idea.

As an aside, the proposal is to implement a standard tax deduction to partially offset the costs of health insurance, not a cash handout to pay for health insurance.

Just to clean up a possible misunderstanding, there’s a link to an actual bill text (PDF) on that site.

In particular, I keep reading that the Republicans “have no (concrete) plan” for replacing Obamacare. It is not true. That plan, and perhaps others, have been floating around for a long time, in some form or another. My argument is not about the merits of any plan (ACA or replacement); my argument is that Trump and the Republicans have a potential policy and propaganda success on their hands, as long as they have some minimum of ACA alternative.

Interesting, thanks! I had read conservative arguments in favor of (a version of) this plan some time ago and they clearly argued that the value of the tax credit was the full amount for everyone, regardless of the amount of a person’s tax. (I’m assuming that is possible; since e.g. we have an equivalent construct for retirement savings tax credit in my country.) So I went with the full amount for everybody.

It does sound exceedingly generous.

Agree with that!

I agree that a UHC policy should have a mandate. But it seems to be a conservative trope that a strong enough incentive can also work.

Obama himself famously seems to have believed it:

More or less what I’m arguing in a nutshell!

A question for those who are promoting alternate plans:
Both My Beloved and I have preexisting conditions (she is a cancer survivor with a bad spine, and I have a congenital heart defect, survived an aneurysm and am diabetic), we are each a year short of 60 and I earn barely too much money to get federal aid.
What have you got that will keep us alive?

No doubt there will be bad and ideologically driven elements in the Republicans’ Obamacare replacement. What we need is an effective opposition to get rid of the sharpest edges, and to negotiate improvements and safeguards (in particular, a smooth transition) in return for support. Is it happening?

Oh. I guess not, then?

This is exactly what I predict as well.

I’m sure Trump will promise that, if you are happy with your current plan you’ll get to keep it (without having to pay too much more).

I more or less expect he’ll keep that promise.

How did you manage before 2010?

Just like he’s kept his other promises.

Democrats could filibuster the bill, right? Would that not be an effective opposition? What incentive do they have to work with Republicans to pass a watered-down version of the Republican bill?

THE REPUBLICANS are the ones who keep saying they have no plan yet. If they DO have a plan, why do they keep saying that, hmmm?


A credit WOULD be the equivalent of cash in hand (after taxes are filed). A credit is a reduction of your taxes owed. A deduction is a reduction of your income taxed. Big deductions are roughly equivalent to small credits. This one, as a deduction, can look huge while being relatively puny.

That was back before The Big C hit My Beloved, and she had just gotten laid off at Sealy.