President Trump did not do much to sell the Senate health care bill before its failure. But he gave the sale a shot Wednesday in the White House before cameras and a captive audience of nearly all the Republican senators. His comments were at times confusing, and in some cases, outright incorrect.
It shows the challenge for a president who doesn't dive deeply into policy to sell his agenda.
Here's a look at everything Trump said, with some fact checks and context:
Trump: We're in this room today to deliver on our promise to the American people to repeal Obamacare and to ensure that they have the health care that they need. We have no choice. We have to repeal and replace Obamacare. We can repeal it, but the best is repeal and replace, and let's get going. I intend to keep my promise, and I know you will too. Since 2013, Obamacare premiums have skyrocketed. In Alaska, they went up over 200 percent recently. We know that. In Arizona, they've been up 118 percent. And those states are good compared to some of the numbers that are coming out.
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NPR: Trump is right that premiums have climbed sharply in Alaska and Arizona. According to a May report from the Department of Health and Human Services, premiums in Alaska were up 203 percent from 2013 to 2017, and in Arizona, they were in fact up by 190 percent. But these figures could be misleading, FactCheck.org noted in May, because the 2013 and 2017 numbers come from two different data sets. More important, he is leaving out important information: for example, that the overwhelming majority of plans bought on the Obamacare exchanges — 85 percent — receive tax credits that shield them from those premium increases. As the Washington Post's Michelle Ye Hee Lee pointed out in a thorough June fact check of the administration's claims on premium hikes, tax credits would shield a hypothetical 40-year-old patient from 2017 premium increases.
Lee also pointed out that comparing 2013 with 2017 is misleading in that not all of Obamacare's provisions had gone into effect by 2013.
Trump: Despite the promise that premiums would decrease by $2,500 on average, they're actually increased by almost $3,000, and even much more than that in some cases.
NPR: At one point, Obama promised that he would sign a "universal health care bill ... that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year." Premiums have gone up, but again, subsidies shielded many people from this. The Department of Health and Human Services under Trump found that individual premiums went up by $244 a month between 2013 and 2017 — or nearly $3,000 over 12 months. This is an apples-to-oranges comparison, though: The Trump health department number comes from individual premiums, whereas Obama's numbers referred to family premiums (aside from the fact that these numbers are already from two different data sets, as noted above). In addition, Trump again does not mention that most Obamacare exchange customers receive subsidies that shield them from premium increases.
Trump: It's crushing the middle class, and the families of the middle class. It's frankly crushing our country. Obamacare was a big lie. "You can keep your doctor" — lie. "You can keep your plan" — lie. It was a lie, directly from the president. You can keep your doctor, you can keep your plan, 28 times he said it — 28 times — and it was a lie, and he knew it was. And now it's hurting this country irreparably.
NPR: Obama was indeed wrong when he said, "If you like your health care plan, you can keep it." PolitiFact called this the "lie of the year" in 2013. And PolitiFact at one point found 37 instances in which Obama said some iteration of this phrase. As far as "hurting this country irreparably," Trump spells out a lot of his opposition to Obamacare here, but it is still true that Obamacare did help sharply bring down the uninsured rate in the U.S.
Trump: Premiums are so high that 6.5 million Americans chose to pay a fine to the IRS instead of buying insurance, the famous mandate.
NPR: In January, the IRS reported that 6.5 million people paid individual mandate penalties in 2015. Notably, that was down from 8 million in 2014.
Trump: We will pay not to take the insurance. People don't understand that. They don't even understand what it is or what it represents. If Obamacare is not repealed in 2018, over 1,300 counties in the United States will have only one insurer, 40 counties will have absolutely no coverage in the exchange, and that number will grow rapidly. And I think those numbers are extremely conservative. I think they're very low.
NPR: In early June, the New York Times estimated that 1,388 counties could be left with one insurer in 2018 and that 45 would have zero to choose from. That could still change in the future, as Trump seems to indicate — more insurers could pull out or decide to jump into more exchanges. Trump doesn't say why he thinks the current projections are conservative, though. In any event, while a one-insurer market isn't optimal, some health industry experts differ on how big of a problem a one-insurer market is.
Trump: I've been here just six months. I'm ready to act. I have pen in hand, believe me. I'm sitting in that office — I have pen in hand. You never had that before. You know for seven years, you had an easy route — "we'll repeal, we'll replace, and he's never going to sign it, but I'm signing it." So it's a little bit different.
NPR: True. And some on the right are upset that two Republican senators who voted for an Obamacare repeal in 2015 — Alaska's Lisa Murkowski and West Virginia's Shelley Moore Capito — are now against a clean repeal.
Trump: But I'm ready to act. For seven years you promised that you would repeal Obamacare. People are hurting. Inaction is not an option. And frankly, I don't think we should leave town unless we have a health insurance plan, unless we can give our people great health care. Because we're close; we're very close.
The other night I was surprised when I heard a couple of my friends — my friends — they really were and are. They might not be very much longer, but that's OK.
I think I have to get them back.
No, you didn't go out there. This was the one we were worried about; you weren't there, but you're going to be. You're going to be.
Look, he wants to remain a senator, doesn't he?
NPR: Trump is referring to Nevada Republican Sen. Dean Heller, who was sitting right next to the president. Heller is considered one of the most vulnerable Republican senators up for re-election in 2018 and was targeted by ads from a pro-Trump group in June, when he refused to support the Senate GOP's Obamacare overhaul. But he has faced protests from activists on the left, too, and his state has voted for the Democratic candidate in the last three presidential elections.
Trump: OK, and I think the people of your state, which I know very well, I think they're going to appreciate what you hopefully will do. Any senator who votes against starting debate is really telling America that you're fine with Obamacare.
NPR: Senators opposed to the repeal-only plan currently on the table have said they are afraid of the uncertainty of not having an immediate replacement. "To repeal, there has to be a replacement," Republican Sen. Lisa Murkowski of Alaska said Tuesday. "There's enough chaos already, and this would just contribute to it."
Trump: But being fine with Obamacare isn't an option for another reason. Because it's gone. It's failed. It's not going to be around.
NPR: False. While there are areas where Obamacare could be strengthened, there's nothing to suggest that Obamacare will fail under current conditions. The markets are thin in some areas, but according to the Congressional Budget Office, they are anticipated to be "stable in most areas" under current law. And in fact, policy uncertainty — caused by both Congress and the White House — is causing premiums to rise and insurers to stay out of some marketplaces. All of that said, there are a few things the administration could do without Congress that would hurt Obamacare.
Trump: We pay hundreds of millions of dollars a month in subsidy that the courts don't even want us to pay.
NPR: The CBO has estimated that these payments, known as cost-sharing reduction payments, would cost the government $7 billion in 2017, or around $583 million a month, on average. As for the courts not "wanting" the administration to pay, that's not quite right. House Republicans originally brought a lawsuit against the Obama administration, questioning the constitutionality of the CSR payments. A judge ruled in favor of House Republicans, but then the Obama administration appealed, and then the Trump administration inherited the lawsuit. While things are in limbo, the Trump administration has continued making the payments, but it has also left uncertain how long it will continue to do so. If the Trump administration stopped making the payments, it could be disastrous for the exchanges.
Trump: And when those payments stop, it stops immediately. It doesn't take two years, three years, one year — it stops immediately.
On the other hand — and I have to say this — a yes vote will let senators debate the future of health care, and suggest different ways to improve the bill. And we're going to do that today. That's what we're going to do at lunch.
We are so close. The way I looked at it, we have no Democrat help. They're obstructionists. That's all they're good at is obstruction. They have no ideas. They've gone so far left, they're looking for single-payer, that's what they want.
But single-payer will bankrupt our country, because it's more than we take in for just health care. So single-payer is never going to work, but that's what they'd like to do. They have no idea what the consequence will be, and it will be horrible, horrible health care, where you'll wait on line for weeks to even see a doctor.
But we're going to expand tax-free health savings account, the HSAs, to increase health care coverage.
NPR: It's not clear how helpful expanding HSAs would be at increasing coverage among lower-income Americans, as higher-income people are more likely to use those accounts. It's also unclear in parts of the president's remarks whether Trump is trying to sell a repeal-only effort Senate Majority Leader Mitch McConnell is proposing or Senate Republicans' so-called repeal-and-replace bill, which failed to get enough support to advance this week. This HSA policy, for example, was in the Senate's revised overhaul bill, but it wouldn't be a part of a repeal-only effort. As the Washington Post's Aaron Blake pointed out on Wednesday, Trump in the course of 36 hours managed to take three different positions on what to do next on health care.
Trump: Getting Washington out of the way and giving more control and funding back to the states. Stabilizing exchanges so that those pre-existing conditions are protected. You know, you listen to [Democratic Minority Leader Chuck] Schumer, and before he even knew what the plan said — he didn't see it — most of the people in this room never saw it — and he was saying, death, everyone's going to die, death, death, death. That's the only thing they're good at. And this is a great plan; this isn't just a good plan. This is far better than Obamacare, and more generous than Obamacare.
NPR: It's hard to say the Senate's recently revised plan is more generous than Obamacare — one big reason is that the Republican bill maintains heavy Medicaid cuts that the original bill included. And a repeal-only bill would likewise be less "generous," in that it could lead to 32 million more uninsured people in a decade than there would be under current law, according to a CBO report published Thursday.
Trump: Saving Medicaid, which is on a really unsustainable path, and let states spend those dollars freely. So the states are going to be able to spend the dollars. And as a smaller entity, the states will be able to take better care of a person with a bad back, with a bad prognosis, with a problem.
NPR: Medicaid is indeed stretched thin in many states. But the question is how to make it more sustainable. Republican repeal efforts have proposed major future cuts to Medicaid spending. But the majority of growth in Medicaid spending, according to Sara Rosenbaum, professor of health policy at George Washington University, is enrollment — that is, that people need it. "So if we didn't have as many poor Americans, or if we had Medicare cover long-term care, or if private insurance did a bang-up job on the opioid crisis," she said, that would mean lower Medicaid enrollment. "It's as big as it is because other forms of insurance don't do those things. So if all employers gave employment benefits to their low-wage workforces, they wouldn't need to get Medicaid as a form of insurance."
As for states being somehow closer to patients under a repeal or replacement scheme, Rosenbaum says she's not sure why that would be; states already administer Medicaid.
Trump: I'd like the federal government to focus on the Middle East, to focus on North Korea, to focus on things where we have very big problems. The states can do a better job than the federal government when it comes to health care, and that's what we're letting you do. And we're committing $45 billion to help combat the opioid epidemic, and some states in particular like that.
NPR: The Senate's recently revised version of its health care bill included $45 billion in funding for fighting this epidemic, but that's likely not nearly enough to make a big difference, as the New York Times recently reported. Senators whose states have been hit by the opioid crisis pushed for more funding than the original Senate bill allotted.
Trump: So my message today is really simple: We have to stay here, we shouldn't leave town, and we should hammer this out and get it done. And not just a repeal. Hey, it was sort of early on, along with a few of the other folks at the table, the repeal was fine. I was — but we ought to get more than — I think the people of this country need more than a repeal. They need a repeal and a replace. And we were very, very close. And then little things happened, but now we're very close again. We have to get it there. Now, with John Cornyn the other night, we had a couple of things that we put down on paper.
NPR: Texas Republican Sen. Cornyn, one of the biggest supporters of the president's health care repeal efforts, joined Trump and other Republican senators for dinner at the White House on Tuesday night.
Trump: I'm just going to read them really fast, but these are some of the things that are done, because the Democrats are always selling their plan, but they don't do that anymore. They don't talk about Obamacare anymore, because they can't, because it's failed; they know it. So they're selling their plan, and we never sell our plan. If we're weak on anything, it's on letting people know how good it was.
NPR: Trump has spent much of these remarks lambasting Obamacare, rather than selling a Republican plan. And as NPR's Ron Elving noted, the president has not been especially involved in that sales pitch.
So we wrote down these few things. Repeals the individual mandate. How big is that? Where people are paying not to have insurance. Nobody ever talks about that.
Repeals job killing employer mandate. How big is that?
Will substantially lower premiums — and remember this — cross country lines, cross state lines, where you have — where it's almost impossible for insurance companies to compete in different states. We can't because of unfortunately the 60 votes put that here, but it's going to come very soon. We're putting it in a popular bill, and that will come. And that will come, and your premiums will be down 60 and 70 percent.
People don't know that. Nobody hears it. Nobody talks about it. But you're going — premiums are going to — we're going to have to cross state lines, not doubt, and you'll have insurance companies bidding, you'll have forms of insurance that you don't even know about right now, because that's the way it works. There's going to be tremendous competition.
So your premiums will be substantially lower.
Repeals burdensome taxes, big.
Will restore choices. The bill also provides for expanded coverage — the options. So you can have a tremendously expanded coverage and options.
Will stabilize insurance markets. The markets right now, by the way, right now are gone; they're a mess. And depending on what happens here, depending what happens over the next couple of weeks, the insurance companies are all fleeing.
Will protect pre-existing-condition coverage. You listen to the Democrats, they say, oh, you're giving it up. You're going to have better pre-existing than they had in their plan, and you're going to be protected.
Will allow the use of pretax dollars to pay premiums.
Will expand the HSAs.
Will devote substantial resources to fight opioid and other substance abuse.
Will provide better coverage for low-income Americans. By the way, low-income Americans under our plan — and we're doing things at this meeting which I think you'll be very happy about, because we're going to spend some more money to make sure everybody is protected.
Will provide better coverage for low-income Americans.
Will improve medical outcomes for low-income Americans.
Puts Medicaid on a sustainable path, which it's not on right now.
Levels the playing field for states when it comes to federal dollars.
Reforms major entitlements, now a principal driver of $20 trillion debt that we have.
NPR: Entitlements are indeed major drivers in the projected growth of the U.S. national debt, along with interest payments. That debt is nearing $20 trillion (and incidentally, Congress will also have to raise the debt limit soon).
Trump: And will redistrict authority from Washington, D.C., to the states, which I've already said, where they can innovate and develop the best practices, and on a smaller basis they'll be able to take care of people better. So we can repeal, but we should repeal and replace. And we shouldn't leave town until this is complete, until this bill is on my desk, and until we all go over to the Oval Office. I'll sign it and we can celebrate for the American people. Thank you very much. Thank you. Thank you very much. Thank you very much. Copyright 2019 NPR. To see more, visit https://www.npr.org.