Watch An Economist Prove Why Trump's Piecemeal Obamacare Repeal Is Unworkable

Jonathan Gruber: “You Can't Have It Both Ways” By Only Keeping Parts Of Affordable Care Act That Poll Well

From the November 14 edition of CNN's CNN Newsroom with Carol Costello:

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CAROL COSTELLO (HOST): So, what does it sound like Trump is trying to do? Is he trying to -- is he going for like an Obamacare-light program?

JONATHAN GRUBER: It sounds to me like Trump is trying to say he's going to protect some of the parts of Obamacare that are most popular without actually laying out a plan for doing so. So, for example, one of the fundamental gains of Obamacare is ending discrimination in insurance markets. No longer allowing insurers to deny insurance coverage to people just because they're sick or charge them higher prices. He hasn't mentioned that. Pre-existing conditions exclusions, that's nice. But that doesn't solve the problem. So my wife, for example, is a breast cancer survivor. What Trump laid out, if she went to the insurer, the insurer could say, “Yeah if we offered you health insurance we'd make sure to cover your breast cancer but guess what? We're not going to offer you health insurance because you're sick.” Trump has to address that problem.

COSTELLO: So, if he keeps -- like I guess this still would have to go through Congress, right? So, let's say he keeps the parts of the law that people really like. What would that do to all of our premiums? If he could keep all of the elements that you say that Congress might reject.

GRUBER: The point is about Obamacare, it's complicated for a reason. The part people like is ending insurance discrimination. Not allowing insurers to deny my wife coverage because she's a breast cancer survivor. However, you can't have that unless you also make sure that people can afford insurance so that the healthy buy it, and you get healthy people into the risk pool. To just say we're going to keep the parts people like and get rid of the parts people don't, we've tried that. Seven states tried that in the 1990s. They tried to tell insurers you can't discriminate against the sick. In every single case it destroyed the insurance market, premiums went through the roof and the insurance market shrunk to a fraction of its previous size. You can't have it both ways. If you want to tell insurers they can't discriminate you need an individual mandate and subsidies to make sure that healthy people come into the pool.

COSTELLO: Why couldn't the government put price controls on insurance companies?

GRUBER: The government could try to put price controls on insurance companies but then insurance companies could: A)exit the market. And say, “I'm just not going to offer insurance in this market.” There's nothing the government can do about that. Or B) deny sick people coverage and say, “At that price I'm not going to offer coverage to sick people.” The point is the government cannot force --


GRUBER: So basically the bottom line is: you can't have it both ways. If you want insurance companies to cover everyone fairly, you have to bring healthy people into the pool. And the only way to do that is with a combination of carrots, which is tax credits to make health insurance affordable, and a stick, which is a mandate to bring the healthy people in to buy insurance.

COSTELLO: I've heard a lot of people say, you know what, there's 22 million people on Obamacare right now, a large majority of them are poor people who can't afford insurance, but if they're tikd off with Obamacare they'll just go to Medicaid. Is it as simple as that?

GRUBER: No, it's not. The 22 million people who are on Obamacare right now are on parts of Medicaid that didn't exist before. So for example, before on Medicaid, if you were a, say, 25-year-old, or say a 30-year-old single woman with no children, and an income of $5,000 a year, you had no access to health insurance. That simply didn't exist. Obamacare, in expanding Medicaid, said we are going to guarantee our poorest citizens, very poorest citizens, a right to health insurance coverage in those states that chose to expand Medicaid. If you take that away, then a woman like that simply has no coverage options.


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