Donald Trump's election could allow Republicans to significantly reduce health care costs

If you're confused, it's not an accident.

Republicans are looking to pursue a two-way approach to health care in the 2024 campaign. They boast that they want to deregulate insurance and slash government spending, but they also say they will never do anything that would jeopardize people's insurance.

These two steps keep them in trouble. House Speaker Mike Johnson was recently caught on tape promising to “hurt the regulatory state.” Johnson told a group of Republican voters in Pennsylvania that he wants to “go big” in a second term because Donald Trump cannot run for a third term. And Johnson said health care will be a “huge part” of the Republican agenda.

One attendee asked Johnson directly, “Is Obamacare bad?” “There is no Obamacare,” Johnson said.

“The ACA is so deeply ingrained that it requires major reform to make it work. We have a lot of ideas,” the House speaker added. He didn't get more specific.

Kamala Harris' campaign quickly flagged Johnson's comments, and Republicans backed off. Donald Trump's campaign said this was “not a policy position of President Trump,” and Trump sought to distance himself further in social media posts.

Prime Minister Johnson insisted he had not actually promised to repeal Obamacare, highlighting his comments that the 2010 law was “entrenched” while ignoring subsequent promises of “major reforms” .

Mr. Trump himself has hinted that he only has “a concept of a plan” when it comes to U.S. health care. That leaves other Republicans to fill in the gaps, and the party's concrete proposals remain unclear. But even if there are still many details to iron out, the theme of Republican health care policy is clear. That is reduction. Cut regulations. Reduce expenses.

Johnson's comments were not an isolated incident. Just last month, President Trump's running mate, J.D. Vance, hinted at a “deregulation agenda to give people the ability to choose the health plan that's right for them.” If you really parse his words about health insurance risk pools, it's a return to the pre-Obamacare world, where you could charge more if you had a pre-existing medical condition. Dew.

It was exactly what Johnson had promised. That's the reality. If Republicans gain control of the White House and Congress in this election, they will seek to cut health insurance for Americans.

Republicans still want significant health care cost cuts

When the Obamacare repeal was repealed in 2017, you might have thought the chapter was closed. Instead, the battle over the future of American health care has entered a new era.

Don't get me wrong. Republican leaders still want to lower health care costs and loosen health insurance regulations.

And no matter what Trump says, traditional conservative health care policies have proven malleable. His people continue to set their sights on healthcare, sometimes in ways that may not be so obvious.

Elon Musk, who sometimes appears to be campaigning to become the shadow president of the United States, has promised to cut $2 trillion from the federal government's $6.8 trillion budget. He acknowledged that the cuts would cause “temporary” difficulties, but insisted they were in the country's long-term interests.

Approximately $1 out of every $5 in the federal budget goes to health care. Absent significant reductions in the U.S. military (which is unlikely), such a plan would require major cuts to health care programs. President Trump has frequently said he would protect Medicare for seniors, but in the past he announced plans to protect Medicare for the elderly, which would provide coverage to 73 million Americans as part of the 2017 ACA Repeal and Replace Act. He supported significant cuts to Medicaid, a program for the United States. .

The main Republican bill to repeal and replace the ACA, which nearly passed in 2017, is actually about loosening health insurance regulations and eliminating individual mandates, while also capping the program's funding. It also stated that establishing the bill would significantly reduce Medicaid.

Republicans may seek to pass an Obamacare repeal bill that would include a comprehensive overhaul of Medicaid. Or they could gradually cut health care, as was seen during the first Trump administration after the failure of the Obamacare repeal bill. President Trump rolled back rules for non-comprehensive plans while cutting funding for ACA marketplace enrollment assistance, resulting in devastating consequences for some patients who didn't know what they were enrolling in. brought about great results.

During President Trump's four years in office, the number of people covered by the ACA fell by more than 1 million to 11.4 million. Since Joe Biden became president and Democrats expanded insurance subsidies as part of the Anti-Inflation Act, the number of people eligible for marketplace plans has nearly doubled to 21.4 million.

If Mr. Trump becomes president again, it seems likely that previous acts of obstruction will be repeated, even if a large-scale repeal effort does not materialize. Republicans could cut aid funding again. Minor changes to health insurance rules, such as raising the premiums that older people can charge compared to younger people and giving insurance companies more leniency in limiting benefits, networks, and other aspects of individual health insurance. Adjustments may be made. It could make more targeted cuts to Medicaid, something that was only blocked by the courts during President Trump's first term, or allow states to once again set Medicaid work requirements.

Why Republicans can't be honest about health care plans

The failure to repeal Obamacare is why Republicans continue to insist that their health care policy is not what it is supposed to be, every time they make their intentions too clear.

Although it's often forgotten now, Obamacare was originally a winning issue for Republicans. They rallied voters against the new health care law and won historic congressional victories in the 2010 midterm elections. They then voted dozens of times to repeal it, in whole or in part, while Barack Obama still held the veto pen. For most of its first decade, the ACA was extremely unpopular.

Then Trump won the presidency, and Republicans had to make good on their promise to repeal and replace the law. Republican leaders brought the new president on board with a fairly conservative plan. It would leave the bones of the ACA in place, but cut its provisions and funding, and make deep cuts to Medicaid.

Then something changed. Health policy reversed as repeal plans began to move through Congress and predictions that millions of Americans would lose health insurance dominated news coverage. This law has quietly grown to cover a significant number of people, more than 25 million people, and just as important, it has changed the way Americans think about the role of government in providing health care. I was starting. The term “pre-existing condition” became a loaded term, and once people understood that Republicans wanted to roll back the ACA's health insurance rules, they objected loudly.

Medicaid also reflects unprecedented political salience, with disability advocates in particular concerned about what cuts to the program would mean for them and their protests The activity was widely reported. State Senate Republicans who expanded Medicaid through the Affordable Care Act were ultimately responsible for blocking the repeal effort.

By the 2018 midterm elections, Democrats had defeated Republicans on health care issues and achieved surprising electoral victories. Now, the ACA is more popular than ever, with U.S. voters saying they trust Democrats more than Republicans on health care.

This series of events left the Republican Party in a predicament. The relative success of the ACA expanded the welfare state and influenced Americans' perceptions of the role of government in ways that were diametrically opposed to conservative economic thought. They want to take back some of these progressive victories. However, changes in health policy must also be kept in mind.

Sometimes, especially in “safe” conservative spaces, they inadvertently admit that they want to lift the ACA and then have to backtrack. Mike Johnson's only mistake was being blunt.

Updated Oct. 31, 3:45 p.m. ET: This article was originally published on Oct. 31 and has been updated to include Trump's social media posts about the ACA.