One of the fundamental concerns for American voters has for years been access to affordable health care. The introduction of the Affordable Care Act in 2010, often referred to as Obamacare, was effective at expanding health-care coverage — but also prompted an immediate backlash on the right. President Trump ran on an explicit pledge to repeal and replace Obamacare with something better, a pledge that sputtered along during 2017 but ultimately resulted only in the removal of one component of the law as part of a large tax-cut package he signed into law that December.
When Trump and his party attempted to gut the law, one effect was that it immediately became much more popular than it had been. In 2018, Democrats ran on a platform of focusing on protecting access to affordable health care, including affordable coverage for those with preexisting conditions. That focus helped the party retake the House.
With his reelection looming, Trump has increasingly promised that he has or will have a sweeping, ideal health-care proposal that will be produced imminently or in two weeks or after some other benchmark is met. In an interview with CBS News’s Lesley Stahl, large chunks of which Trump released Thursday apparently as part of an effort to damage the network’s ratings, Stahl pressed him on these pledges.
In doing so, she elicited two remarkable admissions from Trump. First, that he hoped the Supreme Court would toss the Affordable Care Act in its entirety, something that he has otherwise been loath to admit. Second, that only then would he introduce a replacement bill — something that he does or doesn’t have fully prepared and that he has or hasn’t already begun to release.
Stahl handed Trump’s past promises back to him.
“It’s going to be ready, it’s all ready. It’ll be here in two weeks,” she said, paraphrasing various Trump pledges. “It’s going to be like nothing you’ve ever seen before. And, of course, we haven’t seen it. So why didn’t you develop a health plan?”
“It is developed. It’s fully developed,” Trump replied. “It’s going to be announced very soon.”
“When?” Stahl pressed. “You say that over and over.”
“When we see what happens with Obamacare, which is not good,” Trump replied. “And when we see what happens with Obamacare.”
He went on to insist that his unseen plan would be “much less expensive than Obamacare” and would “take care of people with preexisting conditions.”
“But your plan was to repeal and replace,” Stahl replied. “And if the Supreme Court finishes Obamacare, there will be all these people stranded because there’s no replacement.”
“No, there won’t,” Trump insisted. “We will make a deal, and we will have a great health-care plan — ”
“But you keep saying that,” Stahl interjected.
“ — with less expensive,” Trump continued, “a less expensive and a much better plan.”
“Why haven’t we seen it?” Stahl asked.
“You have seen it,” Trump claimed. “I’ve been putting out pieces all over the place, and we actually have plans. And we have 180 million people right now have a plan. And you haven’t been watching. You haven’t been watching.”
Those “180 million people,” he later clarified, are people who have insurance through private insurers. People who get coverage through work, for example. This, it probably doesn’t need to be said, does not constitute a Trump health-care plan.
Stahl went back to the issue of people who have preexisting conditions, a group that Trump assured her would be “totally protected.”
“How?” Stahl asked.
“They’ll be protected, Lesley,” the president replied.
Stahl, again: “How?”
“I mean, the people with preexisting conditions are going to be protected,” Trump said.
“How?” Stahl asked.
“As they are now,” Trump answered. “In any plan we do, they will be protected. Lesley, people with preexisting conditions will be always protected. Always.”
The way they are protected now through the Affordable Care Act is twofold. First, people with preexisting conditions cannot be denied coverage. Second, that coverage is made affordable by expanding the pool of contributors to health-care policies. A central reason for Obamacare’s mandate that every adult have health-care coverage was so that healthier people would pay into the system and take less out, making it easier for insurance companies to afford clients who take far more out than they put in — if, for example, they have chronic conditions.
That’s a central risk, should the Supreme Court throw out Obamacare, as Stahl noted.
Nonetheless, that outcome was something that Trump saw as a positive.
“But if — if the Supreme Court ends this, Obamacare,” Stahl said, before Trump jumped in.
“Well, we’re going to have to see what happens. It’s got a ways to go,” he said. “I mean, we’ll see what happens.”
After restarting his train of thinking a few times, he continued: “I hope that they end it. It’ll be so good if they end it.”
He explained why it would be good.
“Because we will come up with a plan,” Trump said, before Stahl jumped in.
“Will?” she asked.
“Yeah, we will,” Trump replied.
“But you said it would already,” Stahl continued, clearly pointing out that Trump had already pledged that this plan existed and was just sitting on a shelf somewhere.
“We have large sections of it already done,” Trump insisted. “And we’ve already come up with plans. Take a look at your various secretaries, various plans that we’ve already come up with. And also, you know, a large part of this country has private health insurance.”
He riffed on those with private insurance for a while and on his misrepresentations of what his opponent in next month’s election, former vice president Joe Biden, would do with health care.
“If the Affordable Care Act is determined to be unconstitutional,” Stahl began, with Trump again interjecting.
“Then we’re going to have new — and we’re going to have new and it’s going to be very good,” Trump said.
“You keep saying that and don’t show it to us,” Stahl replied. “And so people with preexisting conditions — ”
“We’ve come up with many plans, Lesley,” Trump again claimed. “And we have — They’re already in existence. If — I’ll tell you what, after this interview, I will show you, short term, longer-term. I’ll show you different plans. We’ve come up with many plans.”
He may here have been referring to the large book that White House press secretary Kayleigh McEnany at one point handed Stahl. In one photograph of the book tweeted by Trump, Stahl is seen opening it to an apparently blank page.
“All of that, I grant you,” Stahl continued. “All of that. But if there is no plan, a replacement plan, and the Supreme Court says that Obamacare goes away, people with preexisting conditions will be stranded.”
“No, no,” Trump insisted.
“And that’s just a fact,” Stahl continued.
“It’s wrong,” Trump said. “It’s wrong.”
“No,” Stahl replied.
“A new plan will happen,” Trump claimed.
“But: will,” Stahl said.
“And we won’t do anything — will and is,” Trump replied. “We won’t do anything and no plan unless we have preexisting conditions covered.”
What’s particularly odd about all of this, of course, is that if Trump had a spectacular new health-care proposal, there’s nothing stopping him from releasing it. He likes to insist that one exists, though, as Stahl made clear repeatedly, his verbiage often gave away the fact that he doesn’t. At times during the 2017 fight over repealing Obamacare, Trump claimed that simply erasing the law would force Democrats to come to the bargaining table, giving him and his party more leverage. Over the course of his exchange with Stahl, he flirted with that idea, too.
The shortest distillation of his view came a bit later in the interview.
“We may be stuck with it if we lose in the Supreme Court, in which case we’re wasting a lot of words,” Trump told Stahl. “If we win, we will come up with a much — and we will do that — come up with a much better health care for much less money, always protecting people with preexisting conditions.”
The idea that Trump would be “stuck” with the law is bizarre in many ways. He’s the president! Come up with a replacement and hand it to Congress! That’s how the law works. But he clearly believes — as he stated explicitly to Stahl — that the best option is for the law to be tossed and something put together in its place. Maybe because it gives him leverage. Maybe just because he dislikes Obamacare instinctually.
Trump is rarely pressed on the obvious inconsistencies in his assertions about health care, in part because he rarely faces an interviewer willing to press him on them. Stahl effectively cuts through the smoke Trump whips up. He has no plan, he has no actual idea for protecting people with preexisting conditions and may not understand the economics of doing so. Most important, he actively hopes that the court will toss the law — an idea that’s obviously contrary to public opinion.
For some reason, Trump thought it was useful to publicize all of this hours before the final presidential debate.