The American Health Care Act – or ACHA; or TrumpCare if you must say it that way – takes a modest middle-of-the-road approach to reforming some aspects of Obamacare. It is therefore reviled by the left for cutting back subsidies slightly by replacing them with refundable tax credits. It is therefore reviled by the right for replacing subsidies with refundable tax credits rather than standard tax deductions.

TrumpCare makes modest attempts to reign in some of the Medicaid expansion that has been a key driver of Obamacare’s expanded coverage. The freeze is delayed to 2020, and incentives are therefore given for people to sign up now before the freeze goes into effect. This angers conservatives. But it also angers progressives because the health care security (an oxymoron by most standards, and one which really means health care entitlements paid for by the government) of Obamacare has been replaced by something just slightly more market-oriented.

And the toughest conundrum of them all: risk pooling. In other words, how in goodness name do you incentivize younger healthier people who are unwilling to take on Obamacare with all it’s conditions and mandates? Because if you don’t, you’re left with the older, sicker patients who drive up costs exponentially and push premiums skyward.

In the Washington Post, Paul Waldman penned an attack article on TrumpCare where he focused on the 30% penalty the current GOP plan imposes if you go without health insurance for 2 months (as opposed to Obamacare’s mandate that penalized people without insurance in a slightly more severe fashion). He writes this about Trumpcare:

If young people make that calculation en masse, the risk pool winds up confined to people who are older and sicker, premiums skyrocket, insurers flee and the whole thing collapses.

Does this sound slightly familiar? As in exactly what has been happening with Obamacare? As in the key weakness of the ACA, a weakness which has been driving up premiums and causing the exchanges to collapse in state after state? This is partisan grenade throwing over relatively minor adjustments to health care policy. Vox, a progressive/radical beacon of activist muck racking journalism – for crying out loud – said this:

A curious thing has happened to the Republican replacement plan as it evolved through multiple drafts; it has begun to look more and more like Obamacare itself. The bill keeps some key features of Obamacare, like giving more help to lower-income Americans, and the Medicaid expansion, in a scaled-back form.

Is TrumpCare true repeal? No it is not. Senator Cruz has outlined in Politico a cohesive plan to use reconciliation to repeal most of Obamacare’s features and replace them with expanded HSA’s (which TrumpCare does do to an extent) and a nation-wide insurance market where lower income people can buy cheaper disaster insurance (high deductibles) and use their HSA money to pay for regular medical expenses. It is truly conservative and runs straight in the face of the progressive view that health care is an entitlement, not a service.

TrumpCare tries to bridge the enormous gap between conservative plans like Senator Cruz’s, and progressive views that would really like a single-payer healthcare plan – like Canada has. And who view Obamacare as a minimum acceptable standard on the road to Canadian style socialized medicine.

That means that TrumpCare is neither Obamacare (although it is very close) nor CruzCare. And it will be attacked from both ends of the spectrum. Trump will indeed own it and it will be interesting to see what further changes are made as the president pushes his plan through Congress. The president will need all the art he is able to muster to get this deal to fly.

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