Health Insurance

Trump promised to protect the sick and the poor. He lied.

Ezra Klein
President Donald Trump speaks while flanked by House Republicans after they passed legislation aimed at repealing and replacing Obamacare, during an event in the Rose Garden at the White House, on May 4, 2017 in Washington, DC.
Getty Images

Donald Trump's budget, alongside the Congressional Budget Office's analysis of the revised American Health Care Act, is a test of our capacity for outrage in American politics. Can we be as shocked about lies told in public, and revealed through appendix tables, as we are about lies told in private and revealed through shadowy leaks? Can we muster as much fury on behalf of the stark facts revealed by the Office of Management and Budget as for the titillating what-ifs being investigated by the Senate Intelligence Committee? Will we care as much about Trump's betrayal of the poor and the sick and the disabled as we do about his betrayal of James Comey and the Israeli intelligence services?

Because make no mistake: Trump lied in public about the most consequential policy decisions he is now making as president. He lied on the trail, and he is lying again now from the Oval Office. His budget, released on Tuesday, is an assault on the poor and the vulnerable, and a repudiation of the economic populism that sent him to the White House. The CBO analysis of the Republican health care bill — which Trump has fought to pass, and promised to sign — reveals the proposal would cost 23 million people their health insurance and force millions more onto the stingy, high-deductible insurance plans Trump promised to free them from.

None of this is interpretation or inference — these are the facts of the budget he put his name on and the health care bill he begged Congress to pass. We are not waiting for any whistleblowers to reveal their secrets or investigators to issue their subpoenas. We have the evidence right in front of us.

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"I am going to take care of everybody," Trump told 60 Minutes before being elected. "I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now." According to the Congressional Budget Office, the AHCA would lead to 23 million fewer people with health insurance than if Trump simply left the system alone.

Trump warned that "there was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us." But it is going to happen with him. The reason so many people lose health insurance under his plan is because they can't afford it, and under Trumpcare, if you can't afford it, you don't get it.

Trump promised he would make sure everyone had health insurance plans with "much lower deductibles." The AHCA removes regulations stopping insurers from offering yet higher deductibles than they do now, and then it shrinks and redesigns its tax credits to push people into the new, cheaper, plans. The results are so dystopic, CBO writes, that it expects millions of people to end up in "policies that would not cover major medical risks."

This isn't splitting hairs. Trump ran as an economic populist. He was a Republican who was for you — the little guy. He was a Republican who was going to protect Social Security and Medicaid, cover everyone with better health insurance, and raise taxes on plutocrats like himself. He lied.

As recently as April 30, Trump told the country that "preexisting conditions are in the bill — I mandate it." He said the AHCA has "a clause that guarantees" protection for anyone with preexisting conditions. In fact, the crucial provision that permitted it to clear the House allows states to waive the Affordable Care Act's protections for preexisting conditions.

The CBO predicts that about a sixth of states would use those waivers, and in those states, "less healthy individuals (including those with preexisting or newly acquired medical conditions) would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all."

But it's not just the health care bill. Trump's budget also represents a breathtaking reversal on core campaign promises with the same result — harming vulnerable Americans.

"I'm not going to cut Social Security like every other Republican and I'm not going to cut Medicare or Medicaid," Trump told the Daily Signal in May 2015. But his budget cuts Medicaid by $1.49 trillion — about half its expected budget — and slashes Social Security's disability insurance program by $31.4 billion.

During the campaign, Trump said his tax plan was "going to cost me a fortune, which is actually true." It is not actually true. He told Meet the Press that "for the wealthy, I think, frankly, [taxes are] going to go up. And you know what it? It should go up." That also wasn't true. His tax plan is a festival of cuts for the richest Americans in general, and for Trump in particular. The AHCA is also, at its heart, a massive tax cut for the rich — the redirection of $600 billion in health subsidies for the poor to tax cuts for the wealthy is the main cause of the bill's coverage losses.

This isn't splitting hairs. Trump ran as an economic populist. He was a Republican who was for you — the little guy. He was a Republican who was going to protect Social Security and Medicaid, cover everyone with better health insurance, and raise taxes on plutocrats like himself.

He lied. And yes, I use that word advisedly. While calling Trump a liar occasionally gives some in the media vapors, there's no other word that fits. Trump is president now. His budget is a vetted document constructed by people appointed by Trump. The American Health Care Act and its likely effects have been exhaustively covered in the press. If at this point Trump doesn't know that he's breaking his promises, then it's because he doesn't want to know. If at this point Trump hasn't bothered to discover he is betraying his supporters, and the people his policies will hurt, then that is the most damning fact of all.

Either way, this is a political scandal of massive proportions. Trump ran promising to protect the sick and the poor, and he is governing in ways that will grievously harm them. We should be outraged.

Commentary by Ezra Klein, editor-in-chief at Vox. Follow him on Twitter @ezraklein.

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