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.
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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.