Replace Obamacare? Trump doesn't even have a pla.

 

(sigh) It's been over 14 years since the Patient Protection & Affordable Care Act was signed into law by President Obama.

It's been over 9 years since Donald Trump came down his gold elevator and promised to repeal the ACA.

For years he kept promising that he had a much better healthcare plan which was always just "Two Weeks" away.

And here we are again. From the debate last night:

LINSEY DAVIS: This is now your third time running for president. you [Trump] have long vowed to repeal and replace the Affordable Care Act, also known as Obamacare. You have failed to accomplish that. You now say you're going to keep Obamacare. Quote, unless we can do something much better. Last month you said, quote, we're working on it. So tonight, nine years after you first started running, do you have a plan and can you tell us what it is?

FORMER PRESIDENT DONALD TRUMP: Obamacare was lousy health care. Always was. It's not very good today. And what I said, that if we come up with something, we are working on things, we're going to do it and we're going to replace it. But remember this. I inherited Obamacare because Democrats wouldn't change it. They wouldn't vote for it. They were unanimous. They wouldn't vote to change it. If they would have done that, we would have had a much better plan than Obamacare. But the Democrats came up, they wouldn't vote for it. I had a choice to make when I was president, do I save it and make it as good as it can be? Never going to be great. Or do I let it rot? And I felt I had an obligation, even though politically it would have been good to just let it rot and let it go away. I decided -- and I told my people, the top people, and they're very good people -- I have a lot of good people in this -- that administration. We read about the bad ones. We had some real bad ones too. And so do they. They have really bad ones. The difference is they don't get rid of them. But let me just explain. I had a choice to make do I save it and make it as good as it can be or let it rot? And I saved it. I did the right thing. But it's still never going to be great. And it's too expensive for people. And what we will do is we're looking at different plans. If we can come up with a plan that's going to cost our people, our population less money and be better health care than Obamacare, then I would absolutely do it. But until then I'd run it as good as it can be run.

LINSEY DAVIS: So just a yes or no, you still do not have a plan?

FORMER PRESIDENT DONALD TRUMP: I have concepts of a plan. I'm not president right now. But if we come up with something I would only change it if we come up with something better and less expensive. And there are concepts and options we have to do that. And you'll be hearing about it in the not-too-distant future.

"Concepts of a plan....in the not-too-distant future."

After nine years, that's what he's come up with.

In any event, here's what VP Harris had to say about the ACA, her prior support of Bernie Sanders' universal Medicare for All proposal and her own 2019 "Medicare for America Lite" proposal:

LINSEY DAVIS: Vice President Harris, in 2017 you supported Bernie Sanders' proposal to do away with private insurance and create a government-run health care system. Two years later you proposed a plan that included a private insurance option. What is your plan today?

VICE PRESIDENT KAMALA HARRIS: Well, first of all, I absolutely support and over the last four years as vice president private health care options. But what we need to do is maintain and grow the Affordable Care Act

...As it relates to the Affordable Care Act, understand, just look at the history to know where people stand. When Donald Trump was president, 60 times he tried to get rid of the Affordable Care Act. 60 times. I was a senator at the time. When, I will never forget the early morning hours when it was up for a vote in the United States Senate and the late great John McCain, who you have disparaged as being – uh, you don't like him, you said at the time because he got caught, he was an American hero. The late great John McCain, I will never forget that night. Walked onto the Senate floor and said no, you don't. No, you don't. No, you don't get rid of the Affordable Care Act. You have no plan.

And what the Affordable Care Act has done is eliminate the ability of insurance companies to deny people with pre-existing conditions. I don't have to tell the people watching tonight, you remember what that was like? Remember when an insurance company could deny if a child had asthma, if someone was a breast cancer survivor, if a grandparent had diabetes? And thankfully, as I've been vice president and we over the last four years have strengthened the Affordable Care Act, we have allowed for the first time Medicare to negotiate drug prices on behalf of you the American people. Donald Trump said he was going to allow Medicare to negotiate dr, drug prices. He never did. We did. And now we have capped the cost of insulin at $35 a month. Since I've been vice president we have capped the cost of prescription medication for seniors at $2,000 a year. And when I am president we will do that for all people understanding that the value I bring to this is that access to health care should be a right and not just a privilege of those who can afford it. And the plan has to be to strengthen the Affordable Care Act, not get rid of it, (in audible) in terms of where Donald Trump stands on that.

Here's VP Harris's official healthcare policy platform from her campaign website:

As Attorney General of California, Kamala Harris took on insurance companies and Big Pharma and got them to lower prices. As a Senator, she fought Donald Trump’s attempts to repeal the Affordable Care Act. 

Vice President Harris will make affordable health care a right, not a privilege by expanding and strengthening the Affordable Care Act and making permanent the Biden-Harris tax credit enhancements that are lowering health care premiums by an average of about $800 a year for millions of Americans. She’ll build on the Biden-Harris Administration’s successes in bringing down the cost of lifesaving prescription drugs for Medicare beneficiaries by extending the $35 cap on insulin and $2,000 cap on out-of-pocket spending for seniors to all Americans. Her tie-breaking vote on the Inflation Reduction Act gave Medicare the power to go toe to toe with Big Pharma and negotiate lower drug prices. As President, she’ll accelerate the negotiations to cover more drugs and lower prices for Americans. As Vice President, she also announced that medical debt will be removed from credit reports, and helped cancel $7 billion of medical debt for 3 million Americans. As President, she’ll work with states to cancel medical debt for even more Americans.

And Vice President Harris has led the Administration’s efforts to combat maternal mortality. Women nationwide are dying from childbirth at higher rates than in any other developed nation. The Vice President called on states to extend Medicaid postpartum coverage from two months to twelve: today, 46 states do so—up from just three near the Administration’s start. 

Vice President Harris will protect Social Security and Medicare against relentless attacks from Donald Trump and his extreme allies. She will strengthen Social Security and Medicare for the long haul by making millionaires and billionaires pay their fair share in taxes. She will always fight to ensure that Americans can count on getting the benefits they earned.

Not a whole lot of depth here, but what it boils down to in terms of hard policy is:

• Making the Inflation Reduction Act's enhanced subsidies for over 20 million ACA enrollees permanent.

• Extending the Inflation Reduction Act's $35/mo insulin cap for Medicare Parts B & D enrollees to everyone.

• Extending the Inflation Reduction Act's $2,000/year prescription drug cap for Medicare Part D enrollees to everyone.

• Speed up the addition of prescription drugs to the Medicare Part D price negotiation list (this year 10 drugs were negotiated; another 15 are supposed to be added in 2027, another 15 in 2028, and another 20 in 2029 and each year thereafter, with Medicare Part B being added as well.

• Canceling more medical debt for more Americans.

• Raising taxes on the wealthy to protect the Medicare trust fund.

None of these are a complete overhaul of the U.S. healthcare system by any means, and most of it was what President Biden already had in mind for his 2nd term in office...but it's all important and all of it would be hugely beneficial to tens of millions of Americans. It's a decent wish list.

The only other big ticket items I would probably add would be baking dental, hearing and vision coverage into traditional Medicare to help combat the cannibalization of it by Medicare Advantage, and finding a resolution to the Medicaid Gap in the remaining nonexpansion states, but otherwise it's solid.

Of course, without a Democratic trifecta, it's pretty unlikely that she'd be able to get any of the bullets above passed for her to sign into law. The only one which might get through without Dems controlling both the House & Senate would be a temporary extension of the enhanced ACA subsidies (another 5 years, perhaps?) as part of one of those "Must Pass" Omnibus spending bills...and even that would still require control of the House, and even then I'd only give it small odds of happening.