How to Understand Trump’s Congress Speech Regarding ObamaCare

An Annotated Summary of the HealthCare Portions of Trump’s Speech: What Trump’s Speech Meant for ObamaCare

Below is an annotated transcript of Trump’s congress speech focused on the section about ObamaCare. We’ll explain the policy that the speech implies. The benefit of reading our summary is that we understand the current law, the historic healthcare proposals from both parties, what the senate and house are doing on both sides of the aisle, and thus what Trump’s rhetoric might actually mean for healthcare.

The above is also true for VOX’s Sarah Kliff who wrote: Trump proposed 5 specific policies to replace Obamacare. Here’s how they work.

I would read our article and her’s, she is an expert, but we catch a few things she misses (this being generally true that she is a great read, as is VOX in general on healthcare, but we tend to catch a few goodies they don’t).

UPDATE 2019: This information is historically relevant in terms of it being opinions and facts on a 2017 speech.

BOTTOMLINE: Trump did little more than elude that he will seek to pass a version of the leaked House healthcare repeal and replace plan. That is actually not the worst case at all for ACA supporters, the further-right Freedom Caucus for example thinks it is too liberal (they are like the Bernie Sanders wing of the Republican party; they are the “populist” wing), but with that said this it isn’t the best case either. Campaign Trump hinted he might be more liberal and more socially conservative than this, but it seems he is leading from the center here. The problem is that the centered plan “delays” the roll out so Republicans can get re-elected before people realize what has happened to their healthcare. I’m not being snooty, this is literally the plan as written. The plan is a mixed-bag and we describe it in annotations below. There is not much more beyond rhetoric and notes to get from the healthcare portion of the speech.

NOTE: Our annotations are in purple, the speech as given by President Donald J. Trump is in black.

Notes on Trump’s First Congressional Address to Congress as it Relates to ObamaCare

Tonight, I am also calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and at the same time, provide better Healthcare.

NOTE: Trump said “repeal and replace”, not “repair”. Those who were calling it “repeal and replace” are vindicated here. While it might be polite to call it “repair”, supporters of the law shouldn’t hold themselves to higher standards than the party making the policy.

Mandating every American to buy government-approved health insurance was never the right solution for America. The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we will do.

NOTE: Trump is implying the mandate will be replaced, we can see that this is the direction that the House is going with their New leaked Repeal and Replace bill.

Obamacare premiums nationwide have increased by double and triple digits. As an example, Arizona went up 116 percent last year alone. Governor Matt Bevin of Kentucky just said Obamacare is failing in his State — it is unsustainable and collapsing.

NOTE: The GOP are trying to spin a “death spiral” narrative to justify their political action on the ACA. You shouldn’t buy into this, it is political rhetoric. There are ongoing cost problems, but the GOP machine helped to create them with their obstruction, 50 + repeal attempts, Rubio blocking readjustment payments, rejection of exchanges, rejection of Medicaid expansion and more. Were those actions justified? Well there are utilitarian and principled arguments for that, but I find them all to be second to the fact when it all comes full circle back around to the “death spiral” narrative they set up. TIP: Aetna’s CEO also said the ACA is in a ‘death spiral’, consider Obama’s DOJ blocked an Aetna merger and the company has made a ton of money since 2010 when the law was passed. The individual market is only a small part of any major insurer’s business. Most of their money comes from employer plans and Medicare, both types of coverage were expanded under the ACA.

One third of counties have only one insurer on the exchanges — leaving many Americans with no choice at all.
Remember when you were told that you could keep your doctor, and keep your plan?

NOTE: Again, this is just rhetoric. Same “Obama told you you could keep your plan, but that wasn’t fully true” line from 2014 (which most of the left panned the second he said it, as it was at best a misspeak). Anyway, health insurance, not #44 ration healthcare. You should know this as #44 isn’t even in office any more and part of what the ACA did was address the rationing crisis (where pre-ACA costs and exclusions prohibited access to care for tens of millions). TIP: Here I would note that Trump says almost immediately after this “we should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges”… but this is spin and not what the leaked bill or GOP house health plan does (see the Continuous Coverage Exclusion provision in ALL GOP plans). We have been warning America about the exclusion for a while, it is going to get real when people finally realize it is there some time in the future after the 2018 congressional elections.

To be super clear here, the “Continuous Coverage” provision acts like it is covering pre-existing conditions, allowing Trump and the GOP to claim they are keeping protections for preexisting conditions, but actually just rolls things back to the way it used to be (where people’ could get charged more for being sick). Or at least that is the worst case version. This is what replaces the mandate. This used to be theory, now it is happening, heed my words on this. Trump supporters will, I assume, not pick up on this.

We now know that all of those promises have been broken.

NOTE: More rhetoric. We don’t know that, and Trump is using word play to avoid having to break promises (he seems like he is promising things, but he is just pushing the House GOP bill).

Obamacare is collapsing — and we must act decisively to protect all Americans. Action is not a choice — it is a necessity.
So I am calling on all Democrats and Republicans in the Congress to work with us to save Americans from this imploding Obamacare disaster.

NOTE: More rhetoric. Like the death spiral thing, Republican obstruction and a lack of repair attempts from 2008 to 2016 make it a little hard to swallow these lines. Still, if Democrats and Republicans can work together this will likely be a better bill. So far Democrats have not been asked for input and nothing actionable has been brought to the table. Strongly support the idea of working together though.

Here are the principles that should guide the Congress as we move to create a better healthcare system for all Americans:

NOTE: From here-forth we get the real meat (the five point plan, which is just five of about ten points in the House Bill). Literally all that is happening below is that Trump is describing some major points from the leaked House ObamaCare Bill.

First, we should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges.

NOTE: This is just wordplay, they are going to implement the Pre-Existing Condition “Continuous Coverage Exclusion” Provision, the leaked bill and past House plans is proof. This provision will replace the mandate (they don’t say it directly, but that is essentially how it works). Again, this is the part where Trump uses wordplay to act like they are covering preexisting conditions.

Secondly, we should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts — but it must be the plan they want, not the plan forced on them by the Government.

NOTE: Yes, the GOP has long planned to expand health savings accounts. I love this, because my income is high enough so this rocks for me (learn about HSAs, they are tax-free in tax-free out and a major feature of ObamaCare too… a feature Trump supporters hate and yell at me about all the time in the comments section). As a supporter of the law and a Sanders voter, it should be pretty sweet to see Republican freak out when they realize that the Republican fix was tax breaks for high earners that require you to stash away thousands of dollars in earnings in an HSA to get the full benefit. As a humanitarian this is all probably frustrating. As a neoclassical economist, or higher earner, this is great. Lots of room to support this, but don’t see how wage workers will like the idea of having to stash away money they don’t think they have (despite the sweet tax advantages of HSAs). Liberals should let this pass, sure it’ll cause some havoc on the budget, but it’ll really hammer home to Trump voters that the core of the Republican plan is about as far from a Workers’ National Populist revolution as possible. Is that mean? I don’t know, I feel like there was a lot of mean going around, savings accounts aren’t at the top of my priority list here. As I said, they are good, they just aren’t great for a large angry chunk of Trump’s base (judging here based on the comment section over the years).

Thirdly, we should give our great State Governors the resources and flexibility they need with Medicaid to make sure no one is left out.

NOTE: The GOP are going to block-grant Medicaid, this is one thing they want more than almost anything else. In the leaked document it shows a few messed up things designed to deconstruct Medicaid at a state level. “Deconstruction by national populists” might sound a little like nods to Reconstruction and National Socialism, but I mean, the far-right aside, I think the average Trump voter voted for States’ Rights and not Third Reichs when we consider all 63 million Trump voters. In that respect, as long as Democrats should make sure to not let them pass a shady version of block grants that hurts working and non-working low-income adults. If states can have more flexibility to provide the programs they want without getting starved by the Trump administration, then we can find common ground here. In other words, no liberal state is going to tolerate the federal government cutting back their Medicaid program. To the extent that that seems to be sort of the plan, the GOP should expect resistance. However, when States’ Rights Federalism is used for the forces of good, “it is good”. Just gotta see the provisions to make a full judgement call here.

Fourthly, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance — and work to bring down the artificially high price of drugs and bring them down immediately.

NOTE: The Republican have wanted legal reforms in healthcare since before the ACA was passed. I imagine they will get their way as there are bigger fish to fry. It depends on the details, on paper this provision seems sensible. I just feel like I’m missing something since some of the rest of this is not as cheery and centered.

Finally, the time has come to give Americans the freedom to purchase health insurance across State lines — creating a truly competitive national marketplace that will bring cost way down and provide far better care.

NOTE: The GOP have also always wanted to sell across state lines. There are pros and cons here, but again, bigger fish to fry. Supporters of the law need to watch out for ways this could leak junk insurance into the market, but that aside, it is one of the more workable of the five points.

Everything that is broken in our country can be fixed. Every problem can be solved. And every hurting family can find healing, and hope.

NOTE: Part of what is broke is tens of millions without access to healthcare and tens of millions struggling with cost. This plan only helps a certain portion of moderately high earners and those without access to cost assistance without health problems and money to put in an HSA. There is a workable foundation here, but we really will need teamwork from both parties to ensure a centered repair plan.

TIP: Trump didn’t mention age based tax credits instead of income based ones, but those are a key feature of the new GOP House plan (the one we are 100% getting and that the far-right and all Democrats and Progressives will be picking bones with). So it is clear, Ryan and the more established parts of the House and Senate are generally in favor of the leaked bill as written, but the far-right Freedom Caucus and others will be pushing back just as hard as the left. So expect some real action soon.

Our citizens deserve this, and so much more — so why not join forces to finally get it done? On this and so many other things, Democrats and Republicans should get together and unite for the good of our country, and for the good of the American people.

My administration wants to work with members in both parties to make childcare accessible and affordable, to help ensure new parents have paid family leave, to invest in women’s health, and to promote clean air and clear water, and to rebuild our military and our infrastructure.

True love for our people requires us to find common ground, to advance the common good, and to cooperate on behalf of every American child who deserves a brighter future.

NOTE: Look, this speech was a great step in the right direction rhetorically. Everyone is going to acknowledge that. But the tone and rhetoric are a second to the policy. The policy here is that of the GOP, and it has essentially not influenced by Trump at this point (we know because we reviewed the House Bill before Trump was even in the race). Credit where credit is due, it will be due when we fight for States’ Rights and the 1332 waiver and Trump supports the people rather than the ideological the far-right. For now, the center and left I’m sure respect the tone, but what we are all looking for here is policy, and the policy on the table and eluded to above is Ryan’s House plan. I already gave my thoughts on that, and we are in the midst of doing a full review of the leak. That will ultimately dictate reactions, this is about healthcare policy, not rhetoric. Sill, if some of the positive rhetoric above can turn into policy, then at that point support has be earned.

TIP: Something people don’t think about, but let me frame it. Right now if you lose coverage for more than 60 days outside of open enrollment you are barred from coverage and owe the fee. That isn’t ideal. However, in liberal states you can get Medicaid if you are low income. Under the GOP plan you can buy back into healthcare for a premium, but there is no open enrollment in which the extra fee goes away. They also seem to want to limit Medicaid via block grants. They also replace income-based credits with age-based ones. The grand result is that wage workers are going to get hurt under both plans, the idea that this is fully “better” is just not grounded in reality. It does some things better and some things worse, solutions aren’t easy to come by, but at this point I think we really do need both Democrats and Republicans (populist and establishment) working together. We know we don’t agree, but we all have a responsibility here. Shifting burdens around isn’t going to fool enough people to win anyone elections. At some point in 2019 the wage worker is going to take a hit from this as written and, well I don’t see how that helps Trump? I actually don’t get who this helps aside from people like me?