The Congressional Budget Office has scored President Trump's health care proposal, and it's not pretty: Around 23 million Americans would lose health insurance under the American Health Care Act. That's alarming — and yet it's only one of many ways in which Trump is breaking his promises on health care.
In the broadest sense, this isn't a huge surprise. It's long been known that repealing Obamacare, which the Trump plan does, would result in millions of people losing their health insurance. While the AHCA contains a few provisions intended to counterbalance this, such as high-risk pools, they're largely symbolic in nature and, according to the CBO, won't prevent the worst fears of repealing Obamacare from being realized. The fact that Republicans want to enact a policy that will strip health care coverage from millions of people is upsetting, but it's not exactly new information.
However, Trumpcare would do more than just kick people off of their health plans. It would raise premiums for sick people, allow insurers to charge more for people with pre-existing conditions, gut Medicaid, and slash Social Security funding. In totality, Trump's proposal would break no fewer than seven other promises he and his administration have made about health care.
1. He Won't Provide "Insurance For Everybody"
"We’re going to have insurance for everybody," Trump said in a January interview with the Washington Post.
But the AHCA will kick millions of people off of their insurance plans, and by 2026, an estimated 51 million Americans won't have health insurance.
2. He Won't Guarantee Coverage For Pre-Existing Conditions
Trump said in early May that his health care plan "guarantees" coverage for people with pre-existing conditions. "Pre-existing conditions are in the bill," he said. "I mandate it."
However, the CBO concluded that under the AHCA, "less healthy individuals (including those with preexisting or newly acquired medical conditions) would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all."
3. He Will Cut Medicare, Medicaid, And Social Security
Throughout the presidential campaign and beyond, Trump was applauded for promising not to touch entitlements. “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” he told the Daily Signal in 2015.
Collectively, the AHCA and the Trump's budget proposal would cut Medicaid funding by 47 percent over the next 10 years. His budget also slashes Social Security's disability insurance by $72 billion over the same time frame.
4. He Will Take Insurance Away From Millions Of People
In addition to Trump's "insurance for everybody" promise, his Health and Human Services Secretary said in March that nobody who currently has insurance will lose it under Trump's replacement. "We don't believe that individuals will lose coverage at all," Tom Price told MSNBC.
According to CBO estimates, Trumpcare will kick 23 million people off of their health insurance plans over the next 10 years.
5. He Will Raise Deductibles, Not Lower Them
In April, Trump claimed that his health care plan will "will have much lower premiums [and] deductibles while at the same time taking care of pre-existing conditions!"
Although the CBO found that the AHCA would reduce premiums on average, it determined that "less healthy people would face extremely high premiums" in certain states, and that "over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly."
6. He Won't "Get Rid Of Artificial Lines"
Coming at things from a slightly different angle, Trump also promised to fulfill a longtime priority of conservative health care reformers: allowing people to buy insurance across state lines.
However, the AHCA does not include any such provision.
7. He Won't Prevent People From "Dying In The Streets"
Trump boasted in January that under his health care plan, "nobody is going to be dying on the streets."
But the AHCA will strip health insurance from roughly 14 million Medicaid recipients, and studies have consistently shown that Medicaid saves lives. By one estimate, one life is saved for every 455 people who received Medicaid under Obamacare's expansion of the program; extrapolating from this, you can estimate that around 30,769 Americans could die as a result of Trump's health care plan.
One caveat: It's possible that these people won't be dying "on the streets." The tens of thousands of people who Trumpcare will kill may instead die in hospitals, or in the comfort of their own homes, so Trump didn't entirely break this promise.