The Last Headcase

Donald Trump's unplanned interview with New York Times reporter Michael Schmidt has been raising lots of eyebrows, mostly for Trump's insane declaration that he has absolute El Jefe power over the Justice department. Wonkette's Five Dollar Feminist looks at the lowest highlights of the full interview, but we'd like to take a closer look at just one of Trump's mystifying attempts to explain policy without getting all tangled up in his own undershorts. (Spoiler warning: The undershorts won, and had to be removed using the Jaws of Life.) So let's jump into the messy slop of word salsa (it was chopped up too much to count as salad) that Trump produced when he tried to show off how much he knows about healthcare policy.

About midway through the interview, Trump spoke, vaguely, about his hope for a bipartisan trillion-dollar infrastructure plan, and the word "bipartisan" reminded him of another thing he'd like to do with the bipartisanship:

I believe we can do health care in a bipartisan way, because now we’ve essentially gutted and ended Obamacare. [No he hasn't -- Dok Zoom] ... Wait, wait, let me just tell you. … Also, beyond the individual mandate, but also [inaudible] associations. You understand what the associations are [...] So now I have associations, I have private insurance companies coming and will sell private health care plans to people through associations. That’s gonna be millions and millions of people. People have no idea how big that is. And by the way, and for that, we’ve ended across state lines. So we have competition. You know for that I’m allowed to [inaudible] state lines. So that’s all done. Now I’ve ended the individual mandate.

Health care reminded him of John McCain's perfidy in voting down "skinny repeal" of the Affordable Care Act, but that was a loss, and he'd rather talk about wins, so he moved on to what a great job he personally did at getting Republicans to pass a huge tax cut, which is like taking credit for teaching a Newfoundland dog to slobber.

Eventually, Trump got to one of our favorite bits in the interview, where he explained he is just the best master of policy you could ever hope to meet:

But Michael, I know the details of taxes better than anybody. Better than the greatest C.P.A. I know the details of health care better than most, better than most. And if I didn’t, I couldn’t have talked all these people into doing ultimately only to be rejected.

Yes, if he didn't know all the policy details, he never could have failed by such a close margin. Unlike that dope Obama, who talked smart and got a flawed but remarkably resilient healthcare plan passed. So, hey, how about a detailed discussion of health care, Mr. "President"?

Now here’s the good news. We’ve created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn’t have insurance. Or didn’t have health care. Millions of people. That’s gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that’s a big thing. And the individual mandate. So now you have associations, and people don’t even talk about the associations. That could be half the people are going to be joining up. … With private [inaudible]. So now you have associations and the individual mandate. I believe that because of the individual mandate and the associations, the Democrats will and certainly should come to me and see if they can do a really great health care plan for the remaining people. [...] But the Democrats should come to a bipartisan bill. And we can fix it. We can fix it. We can make a great health care plan. Not Obamacare, which was a bad plan. We can make a great health care plan through bipartisanship.

See? The man knows all about how he's created associations that millions of people have joined, maybe half the people. And bipartisanship. TOTAL DOMINATION OF POLICY DETAILS.

Just one thing: What the hell was he talking about with these "associations" that millions have supposedly shifted to? Some Twitterfolk have complained that Schmidt should have pushed for clarification of just what the hell Trump was talking about, as if that would have accomplished much. At best, Trump might have said, "You, know, in my executive order," and then shifted to a rantlet about all his many EOs, which he thinks is the same as "legislation," and which have not been reported on by the fake news media.

So yes, that is what Trump was talking about with the "associations": his October executive order that calls on federal agencies to write new rules expanding the ability of consumers to buy "association health plans" and short-term policies, both of which tend to be a lot cheaper than the individual policies in the ACA marketplaces, because they tend to be crappy insurance. Association health plans (AHPs) have been around a long time, and are insurance policies sold to groups of similar small businesses that join together -- an association of mommyblogs or of sofa and quill merchants, for instance -- to purchase health insurance. The idea is to give small businesses the purchasing power of a large employer.

Before Obamacare, these associations would often tailor their "coverage" to meet the insurance standards of states with the most minimal requirements, so those policies could be sold to buyers all over the country, even in states with strong insurance standards. The result was usually cheap, crappy "junk insurance" that often left policyholders responsible for huge medical bills when their care wasn't covered. The ACA treated AHPs like small businesses and required them to provide a full set of essential health benefits and protections for folks with preexisting conditions.

No fun! Trump's executive order would go much of the way back to the bad old days, allowing plans that skirt ACA requirements and opening the way for large association plans that could sell stripped-down policies that would cost less -- and cover as little as the eventual regulations allow. If you want 'splainers by people who really do know the details of health care better than most, better than most, see Vox or WaPo.

Oh, and those new rules aren't actually in place yet. Federal agencies need to propose the rules and have them go through the usual public comment period. So Trump is completely talking out of his ass when he says millions of people have already signed up for the things, because the executive order didn't make them magically spring into existence. Of course, elsewhere in the Times interview, Trump announced that he had brought the coal industry back, so it's really unfair to distinguish between what he says he's done and what he actually hasn't done.

Which is probably just as well, since -- as several experts noted when Trump rolled out his healthcare EO -- AHPs have tended to fall far short of providing good healthcare, and have often been prosecuted for fraud.

Of course there's a simple solution if those marvelous associations turn out to be fraudulent. Trump's administration won't see any need to prosecute them. Problem solved!

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[NYT / Vox / WaPo / Forbes / NYT / Image by Jesse McLaren on Twitter]