A new KFF survey finds that 67 percent of Americans believe “Congress did the wrong thing” when it failed to extend expiring premium subsidies under the Affordable Care Act (ACA) last year. Two-thirds of Americans worry about affording health care costs, according to the same poll, and more than half say their costs have risen in the past year.
The Trump Administration and Republicans in Congress claim health care is a top priority. Yet their proposals to date avoid the obvious fix—extend the subsidies—and offer few real ideas to bring down costs or “fix” the ACA, as long promised.
President Donald Trump’s recently-unveiled “Great Healthcare Plan” is the latest example of this failure. It’s a gimmick-filled mishmash of hoary conservative tropes, vague and unworkable policies, and Trojan-horse proposals designed to further undermine the ACA. It’s also a single page—a hallmark of its lack of seriousness.
“There’s never been and never will be a credible plan to repeal or replace the Affordable Care Act from President Trump and his administration,” says health policy expert Edwin Park, a research professor at Georgetown University and a former health policy advisor to the National Economic Council.
Nevertheless, Republicans in Congress have rallied around the effort of passing the “Great Healthcare Plan,” or some facsimile thereof. It’s all hat and no cattle, but they’re still pretending there’s a rodeo.
The ultra-conservative House Republican Study Committee, for instance, revealed a framework for a second reconciliation bill that largely incorporates Trump’s proposals. (It also proposes even more extreme cuts to Medicaid, including limiting it to citizens.) Republican Senators Mike Crapo of Idaho and Bill Cassidy of Louisiana have also introduced legislation based on Trump’s idea to give households straight up cash for health care. And Trump himself has touted “deals” with more than a dozen pharmaceutical companies to lower drug prices.
“There’s never been and never will be a credible plan to repeal or replace the Affordable Care Act from President Trump and his administration.” - Edwin Park
The Trump administration hopes to bamboozle Americans into believing that the “Great Healthcare Plan” has merit. And the complexity of health care policy lightens that task. That’s why it’s all the more important for Americans to understand the proposal’s many flaws.
In this sneak peek of an upcoming episode for the Monthly’s podcast, Edwin walks through the main planks of the “Great Healthcare Plan” and explains why they won’t fly. For instance:
Trump has released few details of his drug pricing deals, and his “TrumpRx” site debuted this week after months of delays. Edwin says it’s unlikely the prices Trump has negotiated can beat what states already get under Medicaid.
Trump’s “cash for health care” plan will be laughably inadequate and offer scant protection if families face catastrophic health care costs. “They’re talking about a limited sum of money—a thousand dollars,” Edwin says.
Trump calls for “transparency” in medical pricing would have no impact on patients’ bills. “You’re going to have your heart ripped out, and you’re not allowed to negotiate,” Trump said at the press conference announcing his plan. True enough. But “an individual patient is going to have very little ability to get a physician [or] a hospital to lower their prices,” Edwin says, “and that’s even more so in the case of a medical emergency.”
Edwin also raises the alarm on additional proposals included in the Republican Study Committee’s bill and offers his own thoughts on what Congress should do next. Please take a look!
Failing health. For more on the Trump administration’s disastrous health care policies, check out Merrill Goozner’s diagnosis of Trump’s first year performance. His latest piece, shared with the Monthly, argues that the Trump administration’s policies are hazardous to Americans’ health. These failures include anti-vax policies that have enabled the resurgence of preventable diseases and funding cuts that have strangled new research into cures. One thing the administration might get right, however, is cracking down on fraud in the Medicare Advantage program. In a piece shared with the Monthly courtesy of Economic Liberties, Kainoa Lowman explains the scandal over “upcoding” and how it’s bilked the federal government of millions, if not billions, of dollars.
P.S. Don’t be surprised if TrumpRx ultimately gets more pans than Melania. So far, the “discounts” appear available only to people without insurance—and those who are insured are likely to get better deals. (Ozempic, for instance, would cost $199 a month via TrumpRx, compared to $25 a month for those who are insured.) Other pages on TrumpRx, like the one for the diabetes drug Farxiga, simply links to the manufacturer’s rebates page, which raises the question of whether TrumpRx is mere window dressing for discounts that are already available.
Also this week from the Monthly…
How to win the affordability war. Editor in Chief Paul Glastris argues that Democrats have the winning hand on “affordability”—if they choose to play it. In his editor’s note to the Winter issue of the Monthly (see below), Paul lays out a three-part strategy for how Democrats can beat Trump, including the willingness to co-opt the ideas that could work. “The smart move is to see the other party’s bet and raise it,” he writes. Read here.
A big steal? Trump caused considerable consternation this week with his talk of “nationalizing” elections, but Politics Editor Bill Scher counsels there’s no reason to panic. “As with any bully, the way to respond is to have your eyes wide open, but also have no fear,” he writes. Applying Newton’s Third Law of Motion to politics, you’d say that Trump’s maximalist pronouncements tend to provoke equal and opposite reactions. And as Bill points out, there’s plenty of resistance to Trump’s ideas, including among the GOP. Read here. Contributing writer James Zirin likewise argues that the administration’s legally dubious fishing expedition in Georgia will also lead to backlash. Read here.
ICE out. Legal Affairs Editor Garrett Epps argues that current law protects cities like Minneapolis from being forced into “cooperating” with ICE. “Tom Homan has met the enemy, and it is one of the conservative legal movement’s proudest creations: the ‘anti-commandeering’ doctrine,” Garrett writes. While the principles of federalism allow the “encouragement” of states to adopt certain policies, states can’t be “dragooned” into compliance, according to the Supreme Court. The big question, Garrett writes, is how bold the Court will be “now that Trump has sent in actual dragoons.” Read here.
Independence Day. As America approaches its 250th birthday this summer, the spirit of independence should be resistance, urges historian Jack Rakove. “In the light of the past year—or even the past decade—the idea that this is a time for uncritical celebration has become a historical absurdity,” he writes. “In the past few weeks, Minneapolis has become our Boston, and its citizens have become modern Sons of Liberty.” Rakove reminds all Americans to remembers the roots of our country’s founding—as rebels against a tyrant king. Read here.
Bernie the Bro. Polarizing, galvanizing, eccentric, admirable. When the history of 21st century politics is written, few figures will be as important or as memorable as Vermont Sen. Bernie Sanders. But how did Bernie come to be? Kukula Award winner Christoph Irmscher gives us clues in his review of Dan Chiasson’s new biography of Bernie’s early years, Bernie for Burlington. This is no hagiography, Christoph writes, but an honest portrait of a committed iconoclast. And there are anecdotes galore. As a young man, Bernie “had no income to speak of, hitchhiked his way to debates, owned no furniture, and mooched electricity off his neighbors,” Christoph writes. Bernie also got into arguments at nursing homes and once harangued a group of high school seniors. He told them to “stop being ‘docile idiots,’” Christoph relates, “ending up in their good graces only when he called for the legalization of all drugs.” Read here.
Plus…
Constitutional scholar Peter Shane finds hope that the Supreme Court will uphold the Federal Reserve’s independence.
Politics Editor Bill Scher offers three takeaways from the underdog victory of Democrat Taylor Rehmet in a deep, deep red Texas district (hint: Latino voters are fleeing Trump).
Contributing editor Jonathan Alter shares excerpts from his conversation with former Rep. Steve Israel and potential 2028 contender Rahm Emanuel.
Contributing writer David Atkins argues for a constitutional amendment to rein in the presidential pardon power, which has been sorely abused by Trump.
Publisher emeritus Markos Kounalakis warns that Trump’s authoritarian envy is pushing him toward recklessness.
We’ve curated the best of our work in recent months in the Winter print edition of the Monthly. Catch pieces you might have missed from Bill Scher, Garrett Epps, Jack Rakove, Tamar Jacoby, and more.
And elsewhere…
Dreams deferred. The KFF poll noted above isn’t the only recent survey to document Americans’ mounting worries over affordability. The latest New York Times/Siena survey finds “a widespread belief that a middle-class lifestyle is out of reach for most people.” Nearly 6 in 10 voters said they worried about affording basics like rent and groceries, and more than 1 in 10 said they couldn’t afford these necessities as all. Younger voters are especially feeling the pinch, with 75 percent saying they can’t afford the life “they feel like they should be able to afford.” Meanwhile, the Conference Board’s Consumer Confidence survey showed a sharp decline in January—to levels below that of the pandemic. One sure sign of economic worries is the rise of frugality hacks on social media. The Washington Post, for instance, recently reported on “Project Pan,” a viral TikTok challenge encouraging makeup users to “hit the pan” at the bottom of eyeshadows, blushes, and other products before buying more.
Pretty presidential. California Gov. Gavin Newsom recently got the glamour treatment from Vogue, complete with moody black-and-white pics by the redoubtable Annie Liebovitz and rivers of gushing copy. “He is embarrassingly handsome,” writes Maya Singer in an embarrassingly cringey lede that nevertheless reveals a truth in politics: pretty wins. A classic example is the 1960 presidential debate, where a handsome, telegenic JFK crushed the sweaty, makeup-free Richard Nixon. Research backs the point. One 2016 study finds that “attractiveness positively affects vote share” among House candidates. Being tall helps too, which is good news for the 6-foot-3 Newsom. Another study found that US presidents have gotten taller over the years relative to the general population, which the researchers concluded is “consistent with previous findings that height is a heuristic for dominance.” Height and handsomeness were also the hallmarks of America’s OG political hottie: George Washington. Forget the geezer with the wooden teeth. When forensic scientists “de-aged” George Washington for an exhibit at Mount Vernon in 2005, they revealed a portrait of the 6-foot-3 Washington at 19 with “a prominent nose,” a “square jaw,” a “muscular build,” and “piercing gray-blue eyes,” according to The New York Times. “Instead of a white-haired old man, think of a rangy hunk who looks like a quarterback,” wrote the Times’ Warren Leary.
A true profile in courage. WIRED’s Andy Greenberg tells the incredible story of 23-year-old Mohammad Muzahir, who escaped a southeast Asian scam compound and blew the whistle on its operations. Muzahir meticulously documented evidence of how these scammers lured lonely victims with promises of online romance, capturing thousands of pages of screenshots from internal chat logs and recording hours of videos. He also almost got caught and survived beatings and deprivation from his suspicious captors. If there’s anyone who exemplifies the face of resistance and hope despite overwhelming odds, it’s Muzahir.
Aging alone. One reason online scammers are flourishing is the epidemic of loneliness, especially among older adults. In a 2023 survey reported by JAMA, 37 percent of adults ages 50 to 80 said they experienced loneliness, and 34 percent said they felt “socially isolated.” Increasing evidence shows the dangers of social isolation, including screen-time addiction among seniors, and a greater risk of dementia. These problems could worsen as America ages. The Pew Research Center reports that 23 percent of the US population will be 65 or older by 2054, and the number of centenarians will quadruple by 2030. “Social frailty” could well be one of the nation’s top public health concerns.
As always, thanks for reading. Have a great week!
Anne Kim, Senior Editor, Washington Monthly
