“The forgotten men and women of our country will be forgotten no longer,” Trump vowed in his inaugural address. “Everyone is listening to you now.”
They are? The Republican health care plan that Trump endorsed and the budget he just submitted cater more to the interests of the team of billionaires Trump chose for his Cabinet than to the lower-income, rural and older voters who formed the backbone of his electoral support.
Indeed, if you convened a group of health care experts and asked them to design a system guaranteed to alienate those Trump voters, you would come up with something like the American Health Care Act. The bottom line of the Congressional Budget Office number – that 24 million fewer would have coverage by 2026 – actually understates the harms that the proposal would inflict on many Trump voters.
The insurance that people would obtain would have “lower average actuarial values” – CBO-speak for worse coverage. The high co-pays and deductibles about which Trump and other critics of Obamacare rail? “They would tend to be higher than anticipated under current law,” and would climb even higher for the less well-off after 2020, when cost-sharing subsidies are repealed, “significantly increasing out-of-pocket costs … for many lower-income enrollees.”
The new system would hurt the oldest consumers. Insurers would be free to charge those between ages 50 and 64 five times as much as younger enrollees; under Obamacare, that differential is limited to three times as much. It would hurt those with lower incomes, because the tax credits would “tend to be smaller” than the subsidies available under current law, which are more generous to those who earn less – not to mention the extra hit after 2020, mentioned above.
It would hurt those who live in rural areas, with fewer available health care services and therefore higher costs, because the tax credits would be the same across the country, not based on the actual cost of premiums in particular states.
Meantime, the ultra-wealthy would benefit, big-league. The Trump plan would eliminate the additional 0.9 percent payroll tax on earnings and the 3.8 percent tax on investment income for households making more than $250,000. Those in the top 1 percent – making more than $772,000 in 2022 – would reap 40 percent of the benefits, according to the Tax Policy Center.
As former CBO Director Douglas Elmendorf summarized the impact in recent testimony, “I’m baffled that anyone could have watched last year’s election campaign, seen the frustration and anger of many working Americans, and concluded that the most important thing they could do for our country is to make health care unaffordable for tens of millions of Americans of modest means who can afford care now while cutting taxes for the richest Americans.”
Trump appears to be aware of this, except when he isn’t. In an interview with the president, Fox News’ Tucker Carlson cited a Bloomberg analysis that Trump-backing counties would do “far less well under this bill” than those where voters supported Hillary Clinton.
“Well, I know,” Trump replied, then added, “We will take care of our people or I’m not signing it.” Two days later, Trump proclaimed himself “100 percent behind” the “great plan.”
And then there is Trump’s “budget” – in quotes, because it is a particularly bare-bones document that does not include his proposal for a massive tax cut. The latest version of his tax plan would cost $6.2 trillion over the decade, according to the Tax Policy Center, and, again, be heavily tilted toward the richest Americans. Even leaving taxes aside, Trump’s proposals would hurt the voters whose interests he pledged to protect: cuts to job training, college aid, housing assistance, heating costs, rural development, meals for shut-ins, and after-school programs for low-income students. “Draconian, careless and counterproductive,” said one House lawmaker – not a Democrat, but Kentucky Republican Hal Rogers, former Appropriations Committee chairman.
And it’s not like these domestic discretionary spending programs have been swimming in cash – funding levels are already set to be at the lowest levels as a share of the economy since such data collection began in 1962.
Which brings us back to Trump’s inaugural. “For too long,” he said, “a small group in our nation’s capital has reaped the rewards of government while the people have borne the cost.”
How does he explain himself to the people now?
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