Editorial Board

Trump's Warning on Obamacare

The new president has already softened his position. Reality may push him further.

More complicated than it looks.

Photographer: Christopher Furlong/Getty Images

Come Jan. 20, President-elect Donald J. Trump will start carrying out his agenda. How does he expect to turn his promises into policy? Do his plans make sense? If not, what should he do? Finally, given the political realities of Washington, what’s most likely to happen? This is part of a series of editorials that try to answer these questions.

What he says he’ll do: Trump says he wants to replace Obamacare (most of it, anyway) with some arrangement of longstanding Republican proposals. Those include expanding health savings accounts, which let people set aside money tax-free; letting people buy health insurance across state lines, even if doesn’t comply with their own state’s rules; and creating state-run, high-risk pools of subsidized insurance for people who can’t buy private coverage.

Does that make sense? Those proposals, taken by themselves, aren’t objectionable. The question is whether they amount to a “replacement” of Obamacare. And that question turns on a deeper one about the goal of health-care reform. If its point is to expand coverage while controlling costs, Trump’s plan moves in the wrong direction. Repealing the law would increase the deficit by $353 billion over a decade, and cut the number of people with health insurance by 24 million. But that second figure raises a second question: how you define “insurance.” Many conservatives say it is enough simply to offer low-cost, high-deductible plans covering fewer services.

What he ought to do: Trump is right to focus on the price of insurance. But the solution isn’t taking away people’s coverage, or making it less valuable. Better for Trump to direct his vaunted negotiation skills toward persuading health-care providers to go along with changes that Obamacare has started but needs to accelerate, such as changing how doctors and hospitals are paid to reward quality over quantity.

The most likely outcome: The old cliché -- that new government entitlements are harder to take away than to create -- certainly applies to Obamacare. Trump may realize that Americans want to keep the ability to get insurance for pre-existing conditions. How will they feel about losing subsidized coverage, or Medicaid? Do Republicans really want to find out? The new president and his allies in Congress should be careful what they wish for -- otherwise, Obamacare could humble two administrations.

    --Editors: Christopher Flavelle, Michael Newman.

    To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net .

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