Why The Republican Healthcare Proposal Does Not Contain The One Thing Trump Said It Would.
During the campaign Donald Trump was very vague as to what his replacement to Obamacare would actually look like. With one exception he didn’t say much beyond that he would “repeal and replace” Obamacare, while vaguely promising to cover everyone. Just a couple of weeks ago a President clearly in over his head expressed his befuddlement stating “nobody knew health care could be so complicated.” Just for the record, he’s wrong, I (for one) knew.
However, Trump did have one thing he was very specific about. Trump repeatedly promised his new healthcare plan would allow insurers to sell, and people to buy, insurance “across state lines.” This tenet was stated in his campaign website’s position statements, he repeated it in debates, he declared it in speeches. The promise was that this would increase competition and choice for consumers while reducing costs, though even conservative publications like Forbes challenged that premise.
Now with the Republican repeal and replace of Obamacare bill finally released, this singular central tenet of Trump’s plan, the one specific aspect he articulated, IS NOT THERE. In yet another Tweet Trump admits this failing promising that it will be included in “phase 2 & 3 of healthcare rollout.”
It is his own version of you have to pass this bill to see what is in it, and the next bill and the next bill after that. It’s so ironic that that it sounds made up, but it is completely true.
So why is the one thing Trump promised would be in his health plan not in his health plan? The reason is really quite simple. Republicans realize whatever they do to “repeal and replace” Obamacare has to be done by a “reconciliation bill” process. A reconciliation bill is required because such bills are not subject to Senate filibusters. Republicans do not have the 60 votes required in the Senate to quash a filibuster so to repeal Obamacare they must do so through a reconciliation bill that is immune to filibusters.
Why not just include eliminating of state lines in the selling and buying of health insurance in the reconciliation bill? Quite simply because that is against the rules. Reconciliation bills are limited to budget issues. Thus, changes eliminating Obamacare’s tax penalties associated with the individual mandate, while substituting tax credits for buying health insurance, are within the scope of a reconciliation bill, but eliminating state barriers to selling insurance across state lines is not.
As for Trump’s promise to include eliminating state lines in selling health insurance later, in whatever “phase” of his “rollout” that he seeks to do this it shall be subject to a Democratic filibuster in the Senate.