Trump promised to make healthcare better than Obamacare and available to everyone. His plan is a Republican plan at its worse. It is a tax cut for the rich in disguise. Obamacare was able to provide subsidies, so that low income Americans could afford to purchase health insurance, by including a tax on high income Americans. Trump eliminated that tax from his "populist" plan. Consequently, his healthcare plan was forced to reduce government subsidies for the poor. Trump's healthcare plan also satisfies one of Paul Ryan's dreams as a Republican deficit hawk. It allows him to reduce the federal budget deficit. It does this by huge cuts to funding for Medicaid which was an integral part of Obamacare. The Trump plan is a home run for Paul Ryan and most Republicans. It cuts taxes for the rich and it reduces the federal budget with one mighty swat. However, even that was not enough for many Republicans. The plan still includes subsidies for the poor. They will not support any plan that includes government subsidies. They preach a gospel of an insurance market free from government interference in the market. They call themselves the "Freedom Caucus" for a peculiar reason. They want the market to decide who can purchase health insurance. Of course, the market had already decided that prior to the passage of Obamacare. Low income Americans were not able to purchase health insurance in the "good old days' before Obamacare. They were "free to choose" not to purchase health insurance.
Consequently, one of the outcomes of the Trump plan is that millions of Americans will not be able to afford healthcare insurance because of reduced subsidies, and because it eliminates the mandate which requires everyone to purchase health insurance. The mandate, which many freedom loving Republicans hated, helped to keep insurance premiums lower than they would be without the mandate. Premiums will rise without the mandate because of an integral feature of any kind of insurance. That is, those who have fewer insurance claims help to pay for those who have higher claims. Premiums, especially for higher cost older Americans will have to increase.
It should not be surprising that millions of low income Americans will either be without health insurance or they will be forced to purchase lower cost policies with high deductibles. Low income Americans as well as healthcare providers will be forced to make difficult adjustments under Trump's plan. The American Medical Association, the American Hospital Association, as well as the American Association for Retired People have strongly opposed Trump's plan which provides populism for the rich in order to decrease the access to affordable health care.
One might wonder how Trump and his supporters in the Republican Party will defend the plan. George Orwell told us how this is done in his great novel 1984 which has become popular under the Trump regime. The first defense is to argue that the bipartisan Congressional Budget Office (CBO) has not scored the plan properly. Trump praised the CBO when it pointed out issues in Obamacare but he and his surrogates began an attack on the CBO before the results of the scoring were released. Trump and his Republican supporters have invented "alternative facts" as they have been forced to do on many occasions under the Trump regime. However, one of their most sinister defenses has been to distort language much like Orwell predicted. For example, Trump's healthcare plan does not reduce the availability of health insurance; it also does not reduce access to health insurance. Even better it increases freedom of choice. This defense assumes that health insurance is consumed like any other consumer product. For example, a Mercedes Benz is available to every consumer and all consumer have access to a Mercedes. They are also free to choose a Mercedes if that is what they want. However, we all know that the pricing system is a rationing system. The high price of the Mercedes limits its purchase to those who earn enough to purchase it. There is no reason to subsidize the purchase of health insurance as long as we assume, like Republicans do, that healthcare is just another product like a Mercedes. Therefore, it should be rationed by the pricing system.
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