Long before anyone purchased a plan on Healthcare.gov, President Barack Obama repeatedly promised the hundred-plus million people in the country who were already insured— through their employers, or public systems like Medicare and Medicaid—that their coverage wasn’t at risk. “If you like your plan,” he said often, “you can keep your plan.” That infamous guarantee became a powerful weapon in Republicans’ anti-Obamacare arsenal when Americans began receiving cancelation notices from their insurance companies ahead of the law’s 2013 rollout.
Obama’s mantra wasn’t devised to be devious; it was a rhetorical flourish meant to convey in simple terms just how incremental the Affordable Care Act would be. Rather than overhaul the entire health finance system, the law would leave the vast majority of existing arrangements undisturbed, while fixing the dysfunctional individual market for everyone else. “You can keep your plan” was far closer to the truth of the matter than the GOP’s depiction of the ACA as a socialist takeover of the health care system, but Republicans, being fully out of power, weren’t the ones making policy.
Nobody was obligated to interpret Obama’s comments generously, and to this day many people do not. He made a categorical statement that, categorically speaking, wasn’t true. But it is remarkable, thinking back on it, just how damaging that talking point turned out to be. Obamacare creates far more winners than losers; the universe of people whose individual market plans were canceled three years ago is much smaller than the number of people who became newly insured thanks to the law.
Still, the stark contrast between the words “you can keep your plan” and thousands of unexpected cancellation letters made for toxic politics.
It’s been said, and not just by liberals, that President Donald Trump and congressional Republicans are repeating this error with their own promises about the GOP health care plan. Months ago, the conservative health care writer Phil Klein warned Republicans that they were “falling into the same trap that Obama did.”
Since then, House Republicans have introduced and now passed the American Health Care Act, and the extent to which they did not heed Klein’s advice is remarkable. Where “you can keep you plan” was not literally true, many of the promises Republicans made to pass Trumpcare are the kind of up-is-down lies that will, if it becomes law, make Obama’s sales job look like a model of precision. But where Obama could at least point to the above graph as evidence of his benign intent, Republicans will have nothing—no stakeholder support, no major new pool of beneficiaries—to point to as evidence that some larger good compelled them.
To this day, Trump himself uses Obama’s “keep your plan” promise as a kind of shield against criticism for seeking to repeal the law, though he literally made the same promise about Trumpcare word for word. The difference between then and now is that Obamacare filled out a nearly empty individual market, whereas Trumpcare will upend the much more populated individual market he inherited from Obamacare.
But Republicans have compounded this error by making more specific promises to vulnerable subsets of ACA beneficiaries who will be hardest hit, should the American Health Care Act become law. Trump and House Speaker Paul Ryan have both said the bill will protect people with pre-existing conditions as well as or better than Obamacare does.
Republicans are being, if anything, less honest with the very poor than the very sick. The basic trade-off at the heart of AHCA is hundreds of billions of dollars in Medicaid cuts for hundreds of billions of dollars in tax cuts for the wealthy; the Congressional Budget Office says this tradeoff will cause millions of people to be kicked off the Medicaid rolls. And yet, the number-two House Republican says …
… as if people somehow won’t notice when their insurance just disappears.
In the near term, the AHCA has a deeply uncertain future. Due to procedural difficulties and substantive objections, Senate Republicans are reportedly planning to write their own health care bill rather than modify the House plan. It is in many ways easier to imagine them getting nowhere, or passing far more modest legislation with Democratic support, than building on or mimicking the twisted architecture of the AHCA.
It would, by the same token, be an error for Democrats to assume that the contradictions between the bill as written and the bill as Republicans describe it will herald a Democratic revival, whether in next year’s midterm elections or 2020. But the magnitude of the lies that House Republicans had to tell to pass the AHCA is a direct outgrowth of the perversity of the plan, and the deception will become abundantly clear if Republicans ever find themselves in the unenviable position of implementing it.