Democrats, How Is Trump Lowering Health Care Costs?

Immediately after the midterms House Democrats signaled they would investigate how the Trump administration “sabotaged” the Affordable Care Act. Yet, the House may want to change its focus and investigate how the Trump administration is helping to lower health-care costs.

A new report from eHealth shows that “the average lowest price of a Bronze-level health insurance plan is down in 22 of 41 states, and Washington D.C. This is the first time eHealth has recorded such a broad drop in monthly prices for health insurance since major provisions of the ACA went into full effect in January of 2014.”

The administration has not been shy about taking credit for these savings. In September, President Trump’s Secretary of Health and Human Services Alex Azar said, “The President who was supposedly trying to sabotage the Affordable Care Act has proven better at managing it than the President who wrote the law.”

Azar noted that insurers are cutting premiums 2 percent nationally while the number of insurers participating in exchanges is increasing for the first time since 2015.

Azar and other administration officials argue that choice and flexibility are driving down costs. For instance, the administration approved several state reinsurance plans that prevent a relatively small number of sick patients from driving up costs across the board. The administration also made it easier for carriers to standardize essential health benefits across state lines and brought about other technical but important regulatory changes. The administration expanded the use of telemedicine while streamlining and simplifying the process by which medical loss ratios and premiums are figured.

Not surprisingly, critics contend the administration is trying to have it both ways. Even as Secretary Azar is arguing the president is making the law work better than his predecessor, President Trump continues to declare the law to be effectively dead.

This rhetorical montage from President Trump compiled by Robert Pear at the New York Times illustrates this alleged contradiction. Pear writes the president, has “boasted … that he had ‘mostly obliterated Obamacare.’ He said in June that he had ‘essentially gutted’ the law. In July last year, he said his strategy was to ‘let Obamacare implode.’ In October last year, he declared: ‘Obamacare is finished. It’s dead. It’s gone.’”

The contradiction, however, is a matter of appearances not substance. Azar is right that the administration policies are helping to lower costs, which is having the effect of saving Obamacare from itself. At the same time, Trump is not wrong that his administration’s policy of defending patient freedom is gutting the true aim of Obamacare, which was to facilitate a single-payer plan that will take freedom and choice away from consumers and consolidate it in Washington.

At its inception the Affordable Care Act represented an internal compromise within one political party — the Democrats — that was, and still is, divided over how aggressively to push for single-payer health care. In 2013, then-Senate Majority Leader Harry Reid said the country was moving toward single-payer and that we had “work our way past” private health insurance. Reid said, “What we’ve done with Obamacare is have a step in the right direction, but we’re far from having something that’s going to work forever.”

Democrats are angry not because Trump has sabotaged the Affordable Care Act, but because he has sabotaged what Ezra Klein once described as the left’s “sneaky strategy” to implement single-payer health care incrementally. Trump’s patient freedom agenda is a detour many Democrats resent.  

If Democrats want to mount a serious investigation into health-care costs, they should listen to the advice of former Democratic Senator Carl Levin, who recently wrote in Roll Call, “Congress has been at its best when members of both parties donned their institutional role and jointly engaged in meaningful, fact-based, bipartisan oversight of all components of the federal government. That is what millions of Americans voted for on Tuesday, and we urge the leadership in both houses to make it happen.”

Health-care hearings that are designed to gather facts, rather than validate partisan conclusions and campaign slogans, will generate better insights and policies for taxpayers and patients. Democrats may be surprised by what they learn if they study how empowering consumers with real choice and buying power can lower costs.

The fact is neither political party has a monopoly on compassion. Republicans love their family members just as much as Democrats. Effective congressional leaders have always understood that impactful oversight means following the facts, not trying to prove the worst about your opponent or impugning their motives. When it comes to health care, Congress should focus on savings, not stories about sabotage.

John Hart is the former communications director for Sen. Tom Coburn (R-Okla.) and founder of Mars Hill Strategies, a public relations and public affairs firm, whose clients include eHealth.