There’s a reason Donald Trump promised to replace Obamacare with a law that would provide “insurance for everybody”: It’s because everybody wants health insurance. Even the archetypal young, healthy freelancer who chooses to forgo coverage is making a tradeoff to save money but would gladly accept insurance if it were affordable.
As The Daily Beast’s Michael Tomasky reminds us, this created a bit of an embarrassment for Trump when the Congressional Budget Office (CBO) found that the Republican replacement for Obamacare, currently wending its way through Congress, will cost some 24 million Americans their health insurance.
But the Trump administration and its allies are describing that as a feature, not a bug. According to conservative philosophy—which Republicans have just conveniently rediscovered after running on promises to fix infrastructure, protect entitlements, and “take care of everybody” in the health insurance market—millions risking death, disability, and financial ruin for lack of insurance is a good thing.
That’s freedom, you see, and no one can quantify its blessings. “When we get asked the question, ‘How many people are going to get covered?’ That’s not the question that should be asked,” White House press secretary Sean Spicer explained to reporters last week. “The one thing I’m certain will happen is CBO will say, ‘Well, gosh. Not as many people will get coverage,’” House Speaker Paul Ryan said Sunday on CBS’s Face the Nation. “You know why? Because this isn’t a government mandate. This is not the government that makes you buy what we say you should buy, and therefore the government thinks you’re all going to buy it.” Office of Management and Budget Director Mick Mulvaney simultaneously countered questions from George Stephanopoulos on ABC’s This Week with this observation: “You’re worried about getting people covered.”
If Republicans want to preserve their power in 2018 and 2020, they too should be worried about getting people covered. Instead, they seem to have gotten high on their own supply. Republican and conservative political professionals would like to believe that a majority of American voters—or, at least, the large minority who were advantageously distributed geographically that voted for Trump—share their dedication to small-government ideology.
In truth, as demonstrated by Trump’s own campaign strategy, most Americans would prefer to be able to see a doctor when they get sick. That’s why Medicare is so popular and why 58 percent of Americans, according to a 2016 Gallup poll, would favor replacing Obamacare with a fully federally funded health care system.
The GOP’s drift toward extreme social conservatism and outright xenophobia has pushed away educated suburbanites, making the party more dependent on a more blue-collar, older, rural electorate that’s even less committed to limited government.
Weekly Standard editor Bill Kristol nodded to this reality when he said on CNN, “The key is the 14 million who CBO projects, additional, who won’t have insurance next year... How many of those 14 million are young people who didn’t want to buy insurance, were forced by Obamacare to buy insurance, by the mandate, and are now not going to have insurance and they’re not too worried about it, and they can always get it at the end of the day, if they get sick? And how many are older people who got bigger subsidies under Obamacare? If that older people number, the people who were helped more by Obamacare than by the tax credits, is a large number, those are voters. Those are often Republican voters.”
What Kristol fails to appreciate, though, from within his Beltway bubble, is that young people—and their parents—want insurance too. Obamacare has mostly polled better among younger voters than older ones.
And provisions that help young people afford coverage remain popular across the political spectrum. In November, the Kaiser Family Foundation commissioned a poll that found more than 80 percent of Americans, including a majority of Trump voters, support Obamacare’s elimination of out-of-pocket costs for many preventive services and its rule that young adults can stay on their parents’ health insurance until they are 26. Even the Medicaid expansion that so many Republican state governments have rejected polls above 80 percent.
The individual mandate to buy insurance, forcing the healthy into the insurance market, is needed to make all those popular provisions economically viable. That’s why the conservative Heritage Foundation invented the concept in the first place. But after years of inveighing against the mandate as incipient communism, Republicans could not keep it. Without the mandate, they have been left without a bill that will actually cover people. And, without that, they are arguing that the freedom to die in the streets is what they were elected to deliver.
Even Trump himself doesn’t believe this, otherwise he would have campaigned on the promise that he would liberate millions from the oppressive yoke of having health insurance. Rep. Jason Chaffetz (R-Utah) nakedly laid out this logic last week when he told CNN, "Americans have choices, and they've got to make a choice. So rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own health care. They've got to make those decisions themselves.”
As The New York Times reported, even young, uninsured people who voted for Chaffetz in his district found that comment callous. Notwithstanding the fact that people need cellphones to communicate and search for jobs in the modern world, average health insurance premiums are far more expensive than a typical phone plan. That many young people have cellphones but no health insurance doesn’t mean they wouldn’t like to have insurance if they could afford it. In a society as rich as ours, they shouldn’t have to choose between such necessities. If Republicans don’t come to grips with that, they may be punished at the polling booth next year.
