President-elect Donald Trump is already signaling that he might backpedal on his promise to repeal the Affordable Care Act, telling the Wall Street Journal Friday that he’d consider hanging onto popular Obamacare provisions such as “the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.”
His apparent reluctance to scrap the entire ACA is understandable. In the long run, waffling on repeal will probably be less painful than causing a health-care catastrophe. Trump capitalized on Republicans’ long dislike of the Affordable Care Act by focusing on news, in the last weeks of the campaign, that premiums would increase sharply for many Americans purchasing insurance through its exchanges. But he didn’t promise a pared-down health-care regime. He promised to repeal and replace Obamacare with a plan that would cover everyone, offer more choice and cost less.
It was a populist approach to health care that wasn’t new. Sixteen years ago, in “The America We Deserve,” he wrote: “I’m a conservative on most issues, but a liberal on this one,” an appeal that didn’t hurt candidate Trump. But President Trump is likely to find the issue challenging. Repeal requires only the will of Congress. Replacement is subject to the laws of economics and mathematics, which aren’t on his side.
In the campaign, Trump proposed replacing the Affordable Care Act with a tax deduction for individuals who pay for health insurance out of pocket. Like all tax deductions, such a deduction is worth more to people with higher tax rates. But most of those who would be left without coverage by an ACA repeal are lower-income individuals with tax rates that are already low. Thus, the benefit they’d receive from a deduction doesn’t come close to the financial hit they would experience from an ACA repeal. Independent estimates suggest repeal would cause about 20 million people to lose coverage, only one-quarter of whom would purchase insurance with the deduction. The rest wouldn’t be able to afford it.
HENRY KOTULA 