Donald Trump has been ridiculed, rightly, for his answer, during his debate with Kamala Harris, about whether he had a plan for health care coverage that would either replace or improve upon the Affordable Care Act: “I have concepts of a plan.” He has been running for president or sitting in the White House for nine years, and that’s all he has?
But the other day JD Vance, his running mate, gave us a bit more insight into those concepts — concepts that, if implemented, would have the effect of denying health care to millions of Americans, particularly those who need it most.
On Sept. 15 on “Meet the Press,” Vance — after noting that people in good health have very different needs from those with chronic conditions — called for deregulation, saying that we should “promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools.”
It’s not clear whether Vance was laying out a real vision for health policy or just floating his own concepts of a plan. To my ear, however, these remarks by Vance — who is closely associated with the Heritage Foundation’s president, Kevin Roberts, one of the architects of Project 2025 — sounded similar to this airy statement in the Project 2025 manifesto:
The federal government should focus reform on reducing burdens of regulatory compliance, unleashing innovation in health care delivery, ceasing interference in the daily lives of patients and providers, allowing alternative insurance coverage options and returning control of health care dollars to patients making decisions with their providers about their health care treatments and services.
But Vance’s remarks were bad either way. Apart from anything else, he sounded like someone completely unaware of the history of health care economics and the reasons we ended up with the policies we have — someone who completely missed the debates that led to the creation of the A.C.A., a.k.a. Obamacare.
We don’t need to speculate about how his proposal, such as it is, would work, because we’ve seen this movie; that’s exactly how health insurance worked before Obamacare went into effect in 2014, after which insurers were prevented from discriminating based on medical history. Under the pre-Obamacare system, insurers often refused to cover Americans with pre-existing health conditions or required that they pay very high premiums — which meant that they effectively denied health care, in many instances, those who needed it most.
Oh, and attempts to take care of Americans who couldn’t get private insurance, typically through the creation of special, government-subsidized high-risk pools, were dismal failures: unaffordable, underfunded and covering only a small fraction of those needing help.
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