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OPINION 6A THE DAILY ASTORIAN • TUESDAY, MARCH 14, 2017 Founded in 1873 DAVID F. PERO, Publisher & Editor LAURA SELLERS, Managing Editor BETTY SMITH, Advertising Manager CARL EARL, Systems Manager JOHN D. BRUIJN, Production Manager DEBRA BLOOM, Business Manager OUR VIEW Hurdles remain for ‘Trumpcare’ to become law onald Trump and Republicans unveiled their first serious attempt to reimagine the American health-care system after Obamacare. It has not received a favorable response from some, both con- servative and liberal, and its future is in doubt. Obviously, put- ting forward comprehensive health-care reform is difficult work, and it’s no wonder that the first iteration of the Republican plan needs major changes. President Trump said last month: “Nobody knew health care could be so complicated.” But that’s not true. Anyone who has spent hours on the phone with their insurance company, trying to decipher whether a cer- tain physician or procedure is covered by their plan, knows that health care is immensely complicated on an individual and fam- ily basis. Now imagine trying to figure it out for more than 300 million people. Complex is an understatement, especially in a state like Oregon where about 1 in 4 people receive Medicaid benefits. Perhaps the imperfect Affordable Care Act, aka Obamacare, got short-changed for at least getting a few of the many problems under temporary control. But no Republicans voted in favor of the ACA, and many in the past eight years made its repeal their signature campaign promise. So it is no surprise that the bill released last week — supported by Trump and keeping some major tenants of the ACA — has come in from virulent conservative opposition. D Facts are enemies of the people The bill’s highlights Briefly, here’s what the GOP bill would do, if it becomes law: ▪ Repeal both the individual and employer mandates (which allows the government to penalize individuals who go with- out insurance and businesses who don’t offer insurance to their employees). ▪ Repeal government subsidies that reduce insurance costs for consumers. ▪ Reduce the tax credits given to middle-income Americans to help offset insurance costs. ▪ Change the way those subsidies will be distributed. ▪ Scale back Medicaid. ▪ Remove limits on tax-free Health Savings Accounts. ▪ Change the restrictions on how much insurance companies can charge older Americans. Scaling back Medicaid is especially troubling here and could have devastating effects for a quarter of our population. Budget Director Mick Mulvaney, right, accompanied by Health and Human Services Secretary Tom Price, left, speak outside the West Wing of the White House on Monday after Congress’ nonpartisan budget analysts reported that 14 million people would lose coverage next year under the House bill dismantling former President Barack Obama’s health care law. AP Photo/Andrew Harnik What it doesn’t change “Trumpcare” would keep portions of the Affordable Care Act, too, including the ability for children to stay on their parents’ insurance until age 26. It would also: ▪ Keep the requirement of insurers to cover people with pre-existing medical conditions and bars companies from charging those people more. ▪ Keep government-provided essential health benefits, includ- ing maternity care and preventive services. ▪ Keep prohibitions on annual and lifetime limits for how much insurance companies have to pay to cover a customer. So that’s “Trumpcare” in a nutshell. At least version 1.0. The president tweeted, using for the first time the words “my bill.” It would be the first policy directly tied to him that went through the normal channels of how this country was crafted to make legislation — if it can survive that process. Executive orders are much easier and can be done with the stroke of a pen. Trump will soon learn how hard it is to push a massive bill through Congress, even when his party is in control of both houses. Obama was able to do it, but he used up a ton of political capital in the process. Whether Trump has that capital, and the political skill to maneuver his idea through a complex process, remains to be seen. Whether it’s good for America, and especially Oregon, is another question altogether. LETTERS WELCOME Letters should be exclusive to The Daily Astorian. Letters should be fewer than 350 words and must include the writer’s name, address and phone numbers. You will be contacted to confirm authorship. All letters are subject to edit- ing for space, grammar and, on occasion, factual accuracy. Only two letters per writer are printed each month. Letters written in response to other letter writers should address the issue at hand and, rather than mentioning the writer by name, should refer to the headline and date the letter was published. Discourse should be civil and people should be referred to in a respectful manner. Submissions may be sent in any of these ways: E-mail to editor@dailyasto- rian.com; online at www.dailyas- torian.com; delivered to the Asto- rian offices at 949 Exchange St. and 1555 N. Roosevelt in Seaside or by mail to Letters to the Editor, P.O. Box 210, Astoria, OR 97103. By PAUL KRUGMAN New York Times News Service T he U.S. economy added 10.3 million jobs during President Barack Obama’s second term, or 214,000 a month. This brought the official unemployment rate below 5 percent, and a number of indicators sug- gested that by late last year we were fairly close to full employment. But Donald Trump insisted that the good news on jobs was “phony,” that America was actually suffering from mass unemployment. Then came the first employment report of the Trump administration, which at 235,000 jobs added looked very much like a continuation of the previous trend. And the administra- tion claimed credit: Job numbers, Trump’s press secretary declared, “may have been phony in the past, but it’s very real now.” Reporters laughed — and should be ashamed of themselves for doing so. For it really wasn’t a joke. The United States is now governed by a president and party that fundamen- tally don’t accept the idea that there are objective facts. Instead, they want everyone to accept that reality is whatever they say it is. So we’re just supposed to believe the president if he says, falsely, that his inauguration crowd was the big- gest ever; if he claims, ludicrously, that millions of votes were cast ille- gally for his opponent; if he insists, with no evidence, that his predeces- sor tapped his phones. One man’s vanity And it’s not just about serving one man’s vanity. If you want to see how this attitude can hurt millions of people, consider the state of play on health care reform. Obamacare has led to a sharp decline in the number of Americans without health insurance. You can argue that the decline should have been even sharper, that there may be troubles ahead, or that we should have done better. But the reality of the law’s achievement shouldn’t be in question, and you should worry about the consequences of Trump- care, which would drastically weaken key provisions. Republicans, however, are in denial about recent gains. The presi- dent of the Heritage Foundation dis- misses the positive effects of the Affordable Care Act as “fake news.” In Louisville over the weekend, Vice President Mike Pence declared that “Obamacare has failed the people of Kentucky” — this in a state where the percentage of people without insurance fell from 16.6 to 7 percent when the law went into effect. And as for the likely impacts of Trumpcare — well, they literally don’t want to know. When Congress is considering major legislation, it normally waits for the Congressional Budget Office to “score” the proposal — to esti- mate its effects on revenues, outlays and other key targets. The budget office isn’t always right, but it has a very good track record compared with other forecasters; even more important, it has always been scru- pulous about avoiding partisanship, and therefore acts as an important check on politically motivated wish- ful thinking. But Republicans rammed Trump- care through key committees, lit- erally in the dead of night, with- out waiting for the CBO score — and they have been pre-emp- tively denouncing the budget office, which is likely to find that the bill would cause millions to lose health coverage. The truth is that while the office got some things wrong about health reform, on the whole it did pretty well at projecting the effects of a major new bill — and far better than the people now attacking it, who predicted disasters that never hap- pened. And whatever criticisms one may have of its forthcoming score, it will surely be better than the ludi- crous claim of Tom Price, the sec- retary of health and human ser- vices, that “nobody will be worse off financially” as a result of a plan that drastically cuts subsidies and raises premiums for millions of Americans. Attacking legitimacy But this isn’t really about whose analyses of health policy are most likely to get it right. It’s about Trump and company attacking the legitimacy of anyone who might question their assertions. The CBO, in other words, is in the same position as the news media, which Trump has declared “enemies of the people” — not, whatever he may say, because they get things wrong, but because they dare to challenge him on anything. “Enemy of the people” is, of course, a phrase historically associ- ated with Stalin and other tyrants. This is no accident. Trump isn’t a dictator — not yet, anyway — but he clearly has totalitarian instincts. And much, perhaps most, of his party is happy to go along, accept- ing even the most bizarre conspiracy theories. For example, a huge major- ity of Republicans believe Trump’s basically insane charges about being wiretapped by Obama. So don’t make the mistake of dismissing the assault on the Con- gressional Budget Office as some kind of technical dispute. It’s part of a much bigger struggle, in which what’s really at stake is whether ignorance is strength, whether the man in the White House is the sole arbiter of truth.
