Having inexplicably loomed beneath the surface during most of the GOP presidential campaign, has Obamacare now emerged as a major weakness of Donald Trump? The issue’s ultimate effect on the Republican frontrunner will largely hinge on whether Ted Cruz decides to release an Obamacare alternative and thereby make the centerpiece of the Obama presidency a central part of the campaign, and whether Marco Rubio decides to expand on the blueprint for an Obamacare alternative that he has offered up in an op-ed. But even if Trump’s two principal adversaries fail to elevate the issue by trying to demonstrate to voters how they’d offer a genuine path to repeal, Obamacare is already damaging the businessman’s prospects.
Trump’s most cringeworthy moment in the rough-and-tumble Texas presidential debate came when it became clear that, in addition to his not having been in the trenches during the seven years (and counting) of the Obamacare war, he doesn’t seem to have given much thought to Obamacare, or an alternative to Obamacare, at all. Indeed, Trump’s reflections on Obamacare were more reminiscent of when late-night T.V. shows ask random citizens on the streets about current events, for laughs, than of what one would expect from a presidential candidate, let alone a frontrunner.
Trump made five main things clear in the Obamacare part of the debate, all of which make him vulnerable:
One, Trump wants to keep a cornerstone of Obamacare—its mandate that insurers must cover those with preexisting conditions, and at no higher price than what they charge who have been paying their insurance premiums all along. But Obamacare’s preexisting-conditions mandate undermines the very notion of insurance, which dates back at least to the Renaissance. Being for that mandate is akin to being for a mandate that those who sell homeowners insurance must cover those whose houses have already burned down, and must cover them at no higher price than those who were paying their homeowners insurance premiums all along.
Two, Trump doesn’t seem to understand the connection between Obamacare’s preexisting-conditions mandate and its individual mandate, which he recently said he liked and now says he’d repeal. But as a CNN graphic asked during a recent Trump interview, “Without a mandate for all to be insured, why would companies take people with preexisting conditions?” If they did, their prices would skyrocket.
Three, the only identifiable idea that Trump would include in an alternative would be to try to make it easier for insurers to sell policies across state lines, a favorite talking point of Republican politicians that is worth pursuing but raises federalism concerns and likely wouldn’t do all that much good.
Four, Trump seems to have trouble distinguishing between his plan (his alternative) and insurance plans (which people buy for themselves or get through their employer).
Five, Trump has nothing to say about the main (pre-Obamacare) problem with our health-care system—namely, that for 70 years the federal government has played favorites through the tax code, giving a tax break to millions of Americans with employer-based insurance while denying a corresponding tax break to millions of Americans with individually purchased insurance. This tax inequity has largely killed off the individual market, and fixing it is the key to any serious alternative to Obamacare.
Here are the most substantial parts of the Obamacare exchange from the Texas debate:
TRUMP: “I want to keep pre-existing conditions. I think we need it. I think it’s a modern age. And I think we have to have it.”
DANA BASH: “Okay, so let’s talk about pre-existing conditions. What the insurance companies say is that the only way that they can cover people is to have a mandate requiring everybody purchase health insurance. Are they wrong?”
TRUMP: “I think they’re wrong 100 percent….We should have gotten rid of the lines around each state so we can have real competition…we should have gotten rid of the borders; we should have gotten rid of the lines around the state so there’s great competition. The insurance companies are making a fortune on every single thing they do. I’m self-funding my campaign. I’m the only one in either party self-funding my campaign. I’m going to do what’s right. We have to get rid of the lines around the states so that there’s serious, serious competition….”
BASH: “But, just to be specific here, what you’re saying is getting rid of the barriers between states, that is going to solve the problem…”
TRUMP: “That’s going to solve the problem….Look, the insurance companies are making an absolute fortune. Yes, they will keep preexisting conditions, and that would be a great thing. Get rid of Obamacare, we’ll come up with new plans. But, we should keep preexisting conditions”…
RUBIO: “What is your plan?”…
TRUMP: “The lines around the states…”
RUBIO: “That’s your only plan”…
TRUMP: “You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York, or Texas, you’ll have many. They’ll compete, and it’ll be a beautiful thing.”…
RUBIO: “So, that’s the only part of the plan? Just the lines?”
TRUMP: “The nice part of the plan—you’ll have many different plans. You’ll have competition, you’ll have so many different plans.”…
DANA BASH: “If you could talk a little bit more about your plan. I know you talked about…
TRUMP: “We’re going to have many different plans because…
BASH: “Can you be a little specific”…
TRUMP: “There is going to be competition among all of the states, and the insurance companies. They’re going to have many, many different plans.”
BASH: “Is there anything else you would like to add to that…”
TRUMP: “No, there’s nothing to add. What is to add?”
Jeffrey H. Anderson, the author of “An Alternative to Obamacare,” is a Hudson Institute senior fellow.
