DC Deciphered

To top off his first 100 days in office, President Trump gave a long interview to CBS’ John Dickerson this past Sunday on Face the Nation.  Like all Trump interviews, this one was full of odd, conversation-provoking moments – including the moment where Trump ended the interview with a wave of the hand when Dickerson tried to press him on whether he stood behind his claims that Obama wire tapped him.  But out of all of it, of most interest to me is the portion where Dickerson asked Trump about the latest iteration of the GOP health care plan.  This part of the interview generated numerous articles the next day, many of which offered up a similar thesis: Trump doesn’t understand what’s in his own health care bill.

Here are some of the headlines:

An interview suggests Trump doesn’t know what’s in his health bill

How Trump makes it impossible for Republicans to win policy debates

Pushing for Vote on Health Care Bill, Trump Seems Unclear on Its Details

So now I’m going to take issue with that thesis just a bit.  If you’ve been reading DC Deciphered for a while, you know this blog is not likely to defend Donald Trump.  And that’s not what I intend to do now.  Because in large part, those articles are right – it’s very clear Trump doesn’t understand much of what’s in the plan he’s attempting to sell.  However, the most significant detail that all of these articles focused on – and the detail that is at the heart of the debate over the health care bill right now – has to do with preexisting conditions.  And on this particular point, I think Monday’s articles got Trump wrong.

In the interview with Dickerson, Trump claimed that the current version of the GOP bill retains protections for people with preexisting conditions.  This is not true.  (See  this post for an explanation of why, even though the GOP bill does provide those with preexisting conditions access to coverage in the most technical sense, it does not provide protections in any meaningful way).  Monday’s articles talked about this as one piece of evidence that Trump doesn’t understand how the health care bill works.  But if you look more carefully at Trump’s comments on preexisting conditions, you’ll see that on this point at least, he does get it. He’s simply presenting it dishonestly.

Dickerson asks Trump how this health care bill will help his supporters.  Trump begins his response by talking about the preexisting conditions protections that, according to him, are in the bill:

Pre-existing conditions are in the bill. And I just watched another network than yours, and they were saying, “Pre-existing is not covered.” Pre-existing conditions are in the bill. And I mandate it. I said, “Has to be.”

Trump then gets sidetracked talking about some other (supposed) selling points of the GOP bill and has a bit of a back and forth with Dickerson, before coming back around to the subject of preexisting conditions again:

But we have now pre-existing conditions in the bill. We have — we’ve set up a pool for the pre-existing conditions so that the premiums can be allowed to fall.

So we can see here that Trump does understand that under the GOP bill, people with preexisting conditions will be removed from the general insurance pools and put into high risk pools for their coverage.  Then, as he says, this would allow the premiums for people remaining in the private insurance markets to fall.  So Trump gets this discrete detail of the bill. He’s simply making a deceptive claim when he says that this protects people with preexisting conditions (see this post for why high risk pools offer very little value to people with preexisting conditions).

Trump later adds, in an attempt to bolster his case:

I’ll tell you who doesn’t cover pre-existing conditions. Obamacare. You know why? It’s dead.

Now, there are plenty of details about the GOP bill that Trump gets wrong in this interview (such as the claim that the amendment allowing states to request waivers to the preexisting conditions provision is being removed from the bill.  At this point, it appears that Trump gets confused about the bill, but I actually think it’s just a desire on his part to sell the bill as everything to everyone, combined with a complete lack of concern with honesty)*.

In any case, it makes sense that the writers of the articles above concluded that Trump doesn’t know what’s in his own bill.  On the whole, Trump very obviously does not understand what’s in the GOP health care bill.  And the important thing about composing a health care bill is that it works as a whole.  There are tons of moving parts that all interact – if you change one detail, it’s probably going to affect 3 or 5 or 10 other things.  So it’s important to have a very strong grasp of the entire thing.  Trump clearly does not.

But here’s why all these articles declaring Trump doesn’t understand his health care bill were so interesting to me  One of the main claims they focus on as evidence that Trump is confused is the exact same claim that the Republican Party has been making all along about their bill.**

1.Here was Speaker Paul Ryan last Wednesday telling reporters:

“We think the MacArthur amendment is a great way to lower premiums, give states more flexibility, while protecting people with preexisting conditions.”

And then the very next day at his press conference, he was even more enthusiastic, claiming that there are:

“multiple layers of pre-existing condition protections . . . People will be better off with pre-existing conditions under our plan. That’s the whole goal, is to make it easier for people . . .”

2. Rep, Tom MacArthur, the author of the amendment in this latest version that allows states to opt out of Obamacare’s preexisting conditions provision recently said this to CNN:

We need to protect the most vulnerable people in the current plan. These are people with pre-existing conditions. We want to make sure they are protected.”

3. On Meet the Press this past Sunday Chuck Todd asked Vice President Mike Pence Vice President Mike Pence about the fact that people are concerned that protections for preexisting conditions were being removed from the GOP bill.  After deflecting with a whole bunch of other extraneous stuff, Pence responded:

“But we’re also keeping our promises to protect people who have pre-existing conditions.”

Todd went on to ask if that meant the GOP would protect people with preexisting conditions from skyrocketing premiums, and Pence replied (misleadingly, because what he says about Maine is incorrect):

[W]e’re basically borrowing an idea from the state of Maine that has seen a significant drop in premiums for people on their health insurance because you take people that have pre-existing and costly conditions and put them into a high risk pool.

And you subsidize that so that it is affordable to those individuals. And so, you’re guaranteeing coverage for pre-existing conditions.

4. And finally Rep. Dave Brat, a member of the House Freedom Caucus, told a local radio show back home in Virginia:

“And now Vice President Pence has negotiated a compromise where states are able to opt out of some of the Obamacare regulations. It does not affect preexisting conditions,” Brat said. “It does not touch that.”

Those are just a few examples, but you can see the pattern: This is not just about Trump.  This is the standard party line, pushed by some of the most prominent and respected party leaders.  They know that the preexisting conditions provision in Obamacare is the most popular part of the law.  Many GOP members (and Trump himself) ran their 2016 campaigns on a promise to keep those protections.  And even those members who didn’t make that promise can see how popular the idea is.  They don’t want to admit that their bill gets rid of those protections.  So they’re playing semantic games and getting around the issue on technicalities.  As a Party, they have made a decision to lie to the American people.***

Yet when Republicans other than Trump make these false claims, it barely causes a ripple.  Reporters have generally been good about calling the GOP out on these falsehoods during interviews.  But then the moment is over, and these members go on to their next interview or press conference and continue right along making the same claims.  There’s no blowback, no aftermath.  It doesn’t get anywhere near the reaction Trump’s claim is getting, even when it’s someone as high profile as Speaker Ryan.  In fact, I don’t remember seeing any reaction to Speaker Ryan’s lies on this topic in the press at all.

So, I’m not really sure what to make of this.  The GOP, and Ryan in particular, has been regularly claiming that their bill covers preexisting conditions, and the press as a whole has barely batted an eyelash.  And again, I want to be clear about giving credit where it’s due: the press has generally been very good – in the moment – about noting that this claim is not true.  But there hasn’t been any of the sort of mass reaction or backlash that we’re seeing now in response to Trump.

So I think this points to a silver lining about the Trump presidency.  Trump’s way of approaching his new role is so unprecedented, so unusual, so outright shocking much of the time, that it’s forced the media (and the rest of us) to sit up and take notice of everything he does and says.  And yeah, this is exhausting.  But it also means we don’t miss things like this, things that might just slide under the radar when Congress does them because it’s just the same ol’ same ol’ from the GOP.  When it’s Trump acting or speaking, nothing is going to slip by unnoticed.

*****

Notes

*Despite all the claims Trump made in his Sunday interview about how great the current bill is, on Monday he gave an interview to Bloomberg Politics claiming that the bill is not in its final form and that it “will be every bit as good on pre-existing conditions as Obamacare.”  My observation on Trump is that he spins and sells and spins and sells some more, testing his audience.  As he sees what’s working (or not working) he adjusts his sales pitch.  So on Sunday, he gave the standard GOP line on preexisting conditions.  It had been working for the rest of them, so he figured it would work for him.

But by Monday afternoon, it became clear that the same line wasn’t going to work for him because he attracted so much more attention.  So he just threw out a new line, which was that the bill wasn’t in its final form yet.  Of course, when/if no new form of the bill arrives, he’ll  have to go back to arguing that the current bill is great and covers preexisting conditions just beautifully.

**One of the other details many of these articles use as evidence of Trump’s confusion is his claim that the GOP bill will lower premiums and deductibles.  This claim is indeed wrong, or at least extremely misleading.  (It wasn’t true of their original plan, and likely won’t be true of this new plan, though we haven’t gotten a CBO score yet to tell us (obviously those costs will skyrocket for anyone with preexisting conditions under this new plan).  See this post for an explanation of what will happen to premiums and deductibles under the GOP plan).

But it’s bonkers that these articles use this as evidence that Trump doesn’t understand the plan.  The claim that the GOP plan will lower costs is the GOP argument for their plan. Along with some occasional freedom-y type arguments, it has become basically their entire professed reason for the replacement plan.  So every single GOP member who supports the plan (and even many who don’t support it) is making this argument.  Yet there is basically no attention paid when any of the rest of them do it.  There were lots of fact checks of the “lower premiums” claim when the original bill first came out in March.  But then everybody moved on, and the GOP continues to make the claim, and no one bothers to call them out on it anymore, because the focus has moved on to other details (like preexisting conditions).

And at no point was there any of personal focus on individual members for making the claim the way there is now on Trump.  Speaker Ryan – the next most prominent person in D.C. after Trump – has made this claim numerous times.  He’s tweeted this claim over & over again (he just recently even retweeted Donald Trump this claim).  Yet Paul Ryan is never, ever called out on it by the media – either as being confused or as lying.  And he’s got to be one or the other.  So what is happening here??

And Ryan retweet:

*** There are a handful of members of the Party who are not going along with this fiction and are in fact are critical of the bill for not doing enough to protect people with preexisting conditions.  These members are generally not willing to support the bill, and they’re the reason why, as of right now, the bill doesn’t have enough votes to pass the House.