How the House healthcare bill measures up to Trump's promises

President Trump has made some bold promises about the Republican healthcare plan.

In March, he tweeted that the healthcare process will “end in a beautiful picture!” And he’s now one step closer to achieving an overhaul, with the House passing legislation on Thursday to repeal and replace ObamaCare. 

Yet work on the legislation is far from over. Senate Republicans have promised to make major changes to the House’s bill, and the White House has emphasized that the plan is still a work in progress.

In the meantime, here’s a look at how Trump’s promises stack up to the House bill.

“Insurance for everybody” 

“We’re going to have insurance for everybody,” Trump told The Washington Post in January.

It’s unclear whether Trump meant that everyone in the country would have coverage — so-called universal care — or whether he wanted everyone to have access to insurance, the goal that congressional Republicans have emphasized.

The nonpartisan Congressional Budget Office (CBO) found that the House bill would result in far fewer people with insurance than if ObamaCare were left in place. Their analysis, which is now being updated based on changes to the bill, found that 24 million more people would become uninsured over the next decade. 

While some of that drop is due to people choosing not to enroll once ObamaCare’s mandate to have insurance is repealed, much of it is also due to Medicaid cuts and a smaller tax credit to help people afford coverage. 

Lower deductibles 

In the same interview with the Post, Trump said the GOP plan would have “much lower deductibles.”

The House’s healthcare bill would repeal ObamaCare’s requirements that insurers offer the option of more generous plans with lower deductibles, allowing them to only offer skimpier plans with higher deductibles.

As a result, out of pocket costs for enrollees, including deductibles, “would tend to be higher,” the CBO found.

An analysis by the Kaiser Family Foundation found that the average deductible under the GOP plan would rise from $2,550 to $4,100. 

The measure would also repeal ObamaCare financial assistance, known as cost-sharing reductions, that helps low-income people afford deductibles, thereby “significantly increasing out-of-pocket costs,” the CBO found.

Lower Premiums

Trump tweeted in April that the Republican plan would have “much lower premiums.”

The CBO does find that premiums would be 10 percent lower on average by 2026, but there are some caveats.

First, that reduction would only come after an initial increase in premiums of 15 percent to 20 percent. That spike would come due to the repeal of the mandate to have insurance; with the mandate gone, healthy enrollees would be likely to drop out, prompting insurers to raise premiums for everyone else. 

Second, the drop in premiums would come in part because of a younger group of enrollees and less generous plans. A study by Brookings Institution experts found that if the plans and enrollees stayed the same, premiums on average would be about 13 percent higher under the GOP plan than under ObamaCare.

Finally, the 10 percent drop only reflects the sticker price of plans. The financial assistance now provided under ObamaCare to help people afford coverage would on average drop significantly under the GOP plan, by 50 percent over the next decade, according to the CBO. 

Medicaid cuts

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” Trump told The Daily Signal in 2015. 

The GOP healthcare bill includes a large cut to Medicaid: $880 billion over 10 years, according to the CBO.

That cut results from both effectively ending ObamaCare’s expansion of Medicaid after 2020 and putting a new cap on federal payments for the program, which would be a major change in policy. 

The cut would contribute to 14 million fewer people enrolled in Medicaid over a decade, the CBO found.

Every bit as good on pre-existing conditions

Trump told Bloomberg News on Monday that the GOP bill would be “every bit as good on pre-existing conditions as ObamaCare."

The GOP bill contains a provision that bans insurers from denying coverage to people with pre-existing conditions, just as ObamaCare now does.

But unlike ObamaCare, the Republican plan could result in insurers charging people with pre-existing conditions significantly more.

That’s because it would allow states to repeal one of ObamaCare’s core protections for people with pre-existing conditions, known as community rating. If that were repealed, insurers could charge sick people exorbitantly high rates, likely making coverage unaffordable for many. 

To deal with that possibility, the Republican bill provides money for the creation of high-risk insurance pools for people who are seriously ill.

House Majority Whip Steve Scalise (R-La.) this week argued the bill "actually provides multiple layers of protection for people with preexisting conditions." Those include the high-risk pool funding as well as protections against being charged more for an illness if someone maintains continuous coverage without gaps. 

Healthcare experts warn that the House bill does not provide enough funding to cover everyone who would likely need to use the high-risk pools. 

House Republicans added an additional $8 billion for the high-risk pools before passing the bill, but experts say much more funding — to the tune of around $200 billion — would be needed for the pools to really work.