On March 8, Trump laid out his case for the American Health Care Act. Here’s what he said:
It follows the guidelines I laid out in my congressional address: a plan that will lower costs, expand choices, increase competition, and ensure health care access for all Americans. This will be a plan where you can choose your doctor. This will be a plan where you can choose your plan.
These talking points are familiar enough that it’s easy to let them fade into the background. But it’s worth taking them seriously. This is Trump’s case for the bill he’s backing. Does he know that literally every single one of these points is wrong?
The AHCA doesn’t lower costs. Apples to apples, the Brookings Institution estimates “that premiums would be 13% (~$1,000) higher under the AHCA than under current law, holding plan generosity and the individual market age distribution fixed at their current law levels.” To the extent that the AHCA sees lower premiums, it’s because older people can’t afford care and younger people buy sparer plans. That is no one’s idea of lowering costs.
The rest of the problems flow from there. Most people will have fewer affordable choices under the AHCA because their subsidies will be so much smaller (and many people will have no affordable choice at all, and so will go uninsured). Competition is likely to fall as the marketplaces shrink — fewer consumers wielding smaller tax credits will not prove an attractive market to insurers.
The idea that the AHCA will “ensure health care access for all Americans” is sufficiently absurd that I’m not even going to spend time on it.
But the idea that it will let you choose your doctor and plan is more interesting — it seems entirely possible to me that Trump doesn’t realize the limited choices people complain about in Obamacare are the result of people being unable to afford more generous plans with broader networks, and it seems likely to me that he doesn’t know the AHCA will make that problem worse, or why conservative health reformers think that’s a good thing.