Donald Trump and the Republicans are on a runway to disaster if Trumpcare is a bust

David Usborne
Sean Spicer demonstrates why smaller is better when it comes to healthcare laws: Getty

In 1989, Donald Trump bought the hobbled Eastern Airlines Shuttle between Boston, New York and Washington DC, hastily stuck his name on the side of its aging 727’s as well as pink faux-marble basins in the loos in the vague hope the fiddles and upgrades would make it soar again. With typical braggadocio he then made an ill-fated run at buying American Airlines. Why not?

First came a crash-landing when the nose-gear of one of his planes jammed. By 1992, the whole flying ball of twine had unravelled and he was forced to sell up to US Airways, years later bought by the aforementioned American Airlines. It was a debacle he doesn’t mention much but one he surely came to regret.

I’ve got Trump Air/Trumpcare shivers. Right now, the Republican Party – standing in as the Trump Organization nowadays – is attempting to overhaul and refurbish another entity they don’t like the look of. That would be Obamacare. And it looks to me like they are making similar mistakes, rearranging the decor with little to no idea whether what they’ll be left with will fly.

You thought airlines were complicated. Healthcare spending may account for one fifth of the American economy by 2020. It took the Democrats almost two years to craft and usher through the American Care Act (Obamacare), but after concocting a replacement with all new livery – it will now, excitingly, be called the American Healthcare Act – in secret, speaker Paul Ryan wants it passed by the House by yesterday. Hasty doesn’t come close to describing what’s going on. The Ways and Means Committee stayed up until 4am on Thursday to give it its imprimatur.

On Wednesday, chief Trump Air purser Sean Spicer offered proof that the new era of small government has arrived by wheeling a trolley into the press room adorned with two piles of paper, one very tall, the other very short. The tall one was the Obamacare law, the shorter the Ryan replacement. “Look at the size!” he gushed. “This is the Democrats!” – right hand on big pile. “This is us” – hand on short pile. He is running a kindergarten there in the West Wing.

Short is good, so long as all the systems are in place to ensure flight. Which now looks doubtful. Already stripped out are the assorted tax elements built into Obamacare to keep it financially viable, mostly on richer Americans who could afford them and the healthcare industry itself. Gone is the requirement that everyone buy coverage or face tax penalties, a provision meant to give the insurance companies guaranteed numbers of customers so they could comply with other provisions, like not denying coverage to people with pre-existing conditions.

No one would be so dumb as to begin pushing a law as crucial as this one without having some notion of the likely consequences of it. That, to labour the metaphor, would be like taking the cockpit controls blindfolded. Except that that’s exactly what Ryan is doing. The Congressional Budget Office, CBO, exists precisely to forecast the likely financial impact of proposed new laws for federal coffers and indeed for the populace at large. Has it done that yet for Trumpcare? It has not. Last we heard, it will be ready to offer numbers next week. But Ryan couldn’t wait.

Terrified? The good news may be that Ryan has met, er, turbulence. His biggest problem in the House are members on the right who contend that what he is offering is merely “Obamacare-Lite”. They note, for instance, that while subsidies that Democrats devised to help the poorest Americans buy coverage will be gone, they’ll be replaced by a system of tax credits. They don’t see much of a distinction, particularly since it will entail the government writing cheques again for those so poor they don’t pay any federal income tax in the first place.

There is some of that in the Senate too, where majority leader Mitch McConnell means to take up the new law and pass it before the Easter recess. (Yup, all done and dusted and sent to Trump for his signature in the space of a few weeks.) Senators Rand Paul and Mike Lee of Kentucky and Utah are in revolt. But there are some moderate Republicans, like Susan Collins of Maine, who have opposite concerns – that Trumpcare will lead to millions losing coverage.

While the CBO scratches its head, some private bodies have already done the math. It’s not good, especially if you are a poorer or older American. The Kaiser Foundation has published an interactive map showing how much insurance costs would rise or fall for different age groups in all counties in all states. Let’s see. In Palm Beach County where Mar-a-Lago is, a 60-year-old could expect to see a 38 per cent drop in federal help to buy coverage. In Grant County, Nebraska, which fell especially hard for Trump, a person of the same age can expect $16,950 in federal subsidies now and only $4,000 in tax credits if Trumpcare passes as it is now.

“This bill would weaken Medicare’s fiscal sustainability, dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long term services and supports and other benefits,“ AARP senior vice president Joyce Rogers warned Congress.

Ryan has a large enough majority, that he could lose about two dozen of his members and still get his bill through. The outlook for passage in the Senate is far less certain, however. With 52 of the 100 seats in his control, Mr McConnell would survive two defections (with Vice President called in to break a tie) but not three. A parade of moderate Republicans is already vowing not to pass the bill as is, but rather to open up it up for amendments. That, however, is when the whole process may be spin apart because the only consensus about this on Capitol Hill rests with the Democrats who want Obamacare left alone. Republicans are all over the shop.

You wouldn’t know this from Trump, who took to Twitter on Thursday to dispel all doubts about the enterprise. “Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!” he wanted the country to know.

He tried something of the same salesmanship upon purchasing his shuttle airline nearly thirty years ago. “It’s a diamond, it’s an absolute diamond,” he boasted. Except that it wasn’t. The Republicans are prying open Obamacare and trying to make into something else for the sake of it. Or for the sake of ideology. They may come seriously to regret that too if it crash-lands.

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