Bold Promise to Repeal Obamacare Will Be Hard to Keep

As a candidate back in July 2015, Donald Trump promised that he would repeal Obamacare and replace it with "something terrific."The Senate voted, 51-48, on Thursday morning for a measure setting Congress on the path toward repealing President Barack Obama's health care law, and Trump is now a few days from taking office. The public, however, knows little more about his proposal than it did in 2015.In comments to The New York Times on Tuesday and in his news conference on Wednesday, Trump said a Republican health reform bill would be released "very quickly." But he has yet to give details about the policies it would contain.Trump accurately describes problems with the current health care system for Americans under 65: "You have deductibles that are so high, that after people go broke paying their premiums, which are going through the roof, the health care can't even be used by them because their deductibles bills are so high."Mitch McConnell, the Senate majority leader, and House Speaker Paul Ryan have also spoken forcefully in recent days about how health care is too expensive.Pricey health carePremiums for health insurance plans in the United States are high. And increasing deductibles can make needed coverage a financial stretch even for the insured. Recent polling from the nonpartisan Kaiser Family Foundation suggests that the public agrees with Trump's assessment: High out-of-pocket spending on health care is Americans' No. 1 health care concern. (Trump has promised that he will not make major changes to Medicare, the program for Americans 65 and older.)But solving those problems is not as easy as identifying them. The real reason health care premiums and deductibles are so high is that medical care is expensive in the United States -- far more costly than it is anywhere else in the world. The United States pays high prices to doctors and hospitals and drug and device makers, and Americans use a lot of that expensive medical care. That means that the country spent far more on health care than its peers even when tens of millions of Americans lacked health coverage.Obamacare has been successful in getting health insurance to people who lacked it before. About 20 million more Americans had insurance last year than before the law was enacted, according to an Obama administration estimate. But the health law, largely focused on health insurance regulation, did not drive down the cost of medical treatments. Health care -- and health insurance -- continues to be expensive.That means that a GOP health plan that is cheaper and better than Obamacare will be hard to deliver.Republicans in Congress and right-leaning think tanks have put together a number of possible Obamacare replacement plans. They are all slightly different, and it is unclear which one Trump and congressional leaders will choose. But none of them solve both sides of the "less expensive and far better" equation.Most of the Republican plans manage to be less expensive for the federal government -- by offering stingier federal payments helping people buy insurance and allowing the coverage people buy to be skimpier. But those proposals will tend to increase, not decrease, the amount many Americans spend on their health care.Losing coverageLower-income people will end up paying a larger share of their income to buy coverage than they do under Obamacare. Deductibles and other forms of out-of-pocket spending, capped under Obamacare, will tend to rise in many plans. Millions to tens of millions fewer Americans will have coverage under such plans, according to independent estimates.  Continue reading...