Trump’s latest comments prove he has no idea how health policy works

The president says he knows “the subject well.” Everything else he says indicates otherwise.

CREDIT: AP Photo/Evan Vucci
CREDIT: AP Photo/Evan Vucci

Despite claims to the contrary, President Donald Trump still does not appear to understand his own health bill—much less health policy in general.

“Some of the Fake News Media likes to say that I am not totally engaged in healthcare,” he tweeted Wednesday. “Wrong, I know the subject well & want victory for U.S.”

That doesn’t seem to be the case. One senator supporting the Senate GOP’s health bill left a meeting with the president on Tuesday concerned about Trump’s comprehension of the legislation, according to the New York Times. When one “moderate Republican” reportedly complained that the bill would be seen as a tax break for the rich, Trump said he would address tax reform at a later date — completely ignoring the tax implications inherent in repealing the Affordable Care Act (ACA) and replacing it with the Senate’s bill.

Trump’s lack of familiarity with the bill’s contents was made evident by the exchange, but this is only the latest indicator from Trump that he doesn’t have the slightest idea how health policy works — his own, or anyone else’s.

Trump does not seem to understand how much health care costs

Railing against the cost of the ACA, or Obamacare, is a favorite past-time of the president. He has promised lower premiums and deductibles, no cuts to Medicaid, and and a replacement to Obamacare that will cover everyone — even those with pre-existing conditions. Along with many Republicans, Trump has also insisted that government shouldn’t be forcing citizens to pay for the health care costs of other citizens.

But in an effort to avoid spreading out the cost of coverage, Trump threatens to make health care much more costly. The Senate’s health care bill would do almost exactly everything the president promised it wouldn’t, leaving 22 million fewer Americans uninsured and slashing Medicaid. It would also cause average premiums to rise before 2020 (at which point they’re estimated to fall by 30 percent — largely because plans will offer less comprehensive coverage and pay a smaller percentage of costs.)

If the Senate bill becomes law, out-of-pocket costs are expected to rise for most Americans, and deductibles will rise. In states that choose to waive covering certain essential health benefits, those having children or in need of prescription coverage or mental health care could see their costs rise even more.

Rather than saving $400 to $900 billion in government spending, as Trump estimated, the the bill will save taxpayers $321 billion by 2026, according to the Congressional Budget Office. However, the CBO also notes that many people, especially older and low-income Americans, will see their costs spike. Meanwhile, one of Trump’s most eyebrow-raising comments to date on health care might be the suggestion that health insurance should cost $15 per month — something anyone familiar with insurance coverage would know is absurd.

Trump does not seem to understand how Obamacare plans work in practice

In February of 2016, Trump told Sean Hannity that his employees “don’t have to worry about Obamacare” because “I treat them really good with health care.”

Months later, he seemed to walk back that claim. “All of my employees are having a tremendous problem with Obamacare,” Trump claimed in October 2016, later factoring himself in as well. “I don’t use much Obamacare,” he told Fox News, “because it is so bad for the people and they can’t afford it.”

Both comments indicate that Trump does not actually understand how Obamacare works. For one thing, Trump’s employees virtually all received insurance through their employer, not the state exchanges. Meanwhile Trump, a senior citizen, is eligible for Medicare. The point of Obamacare was to cover the many people in the United States without health insurance — not those already covered by employer or government-provided plans. Those not covered by other plans could purchase insurance on the individual market; previously, pre-existing conditions and other factors might have impaired their ability to buy insurance directly.

Trying to make sense of Trump’s October comments about his employees, a reporter asked for clarification. “So none of them are on Obamacare?”

“No — well, some of them are, but most of them no,” Trump replied, further confusing the issue.

Trump does not know what specific policies are in the American Health Care Act (AHCA), or Trumpcare

During an April interview with John Dickerson of CBS News, Trump was asked to explain the AHCA’s contents — something he was unable to do. “This bill is much different than it was a little while ago, okay?” he hedged.

When challenged by Dickerson to explain how the bill had been altered to provide care for those shut out, Trump repeated the same talking points.

“We’ve made many changes to the bill,” he said. He then launched into a tirade against Obamacare.

The exchange highlighted both Trump’s lack of familiarity with his own bill and his focus on attacking his predecessor’s legislation. As Dickerson repeatedly attempted to gain Trump’s assurances on pre-existing conditions, the president failed to offer a concrete response. “Pre-existing conditions are in the bill,” he said, before launching into another Obamacare critique.

“I’m asking about what you’re going to do,” Dickerson interjected. Trump then offered that cross-state competition would allow for insurance companies to compete, which Dickerson rebutted.

“That’s not in this bill,” he said.

“Of course it’s in,” said Trump.

And, lest we forget: Trump was surprised by how “complicated” health care policy is

In February, Trump began to realize how big a challenge it would be to reform health care policy. “Now, I have to tell you, it’s an unbelievably complex subject,” he told a meeting of governors. “Nobody knew health care could be so complicated.”

A month later, he still seemed uninterested in learning the nuances of health policy when members of House Freedom Caucus asked him for clarification on numerous points concerning the health bill during a meeting.

“Forget about the little shit,” Trump reportedly said. “Let’s focus on the big picture here.” (“We’re talking about one-fifth of our economy,” one attendee later told Politico in frustration.)

But incidents like this don’t seem to have fazed the president, who remains very confident about his familiarity with health policy.

“In a short period of time,” he told Time Magazine in May, “I understood everything there was to know about health care. And we did the right negotiating, and actually it’s a very interesting subject.”