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Jonathan Cohn Profile picture
@CitizenCohn
Sep 19 • 14 tweets • 4 min read • Read on X
JD Vance's reference to "risk pools" on Sunday was like a Bat-Signal to those of us who follow health care policy 🧵
Among those who noticed were @jonathanchait ... nymag.com/intelligencer/…
... and @brianbeutler ... offmessage.net/p/vance-trump-…
... and @BenjySarlin ... semafor.com/article/09/17/…
... and @larry_levitt ...
... and @stevebenen ... msnbc.com/rachel-maddow-…
... and yes, me huffpost.com/entry/trump-va…
The reason is that Vance was making the same argument that conservatives have long made about health care -- and that they made in 2017, when they were trying to repeal the ACA huffpost.com/entry/trump-va…
The approach other countries take -- and that's embedded in the ACA -- is to increase the cross-subsidy between healthy and sick and (ideally) get to one giant insurance pool huffpost.com/entry/trump-va…
Conservatives want to push in the other direction, with different insurance for pools with different levels of risk

I.e., reverting to something more like the old, pre-ACA system huffpost.com/entry/trump-va…
Vance was careful to say it was important to cover everybody and in theory that's possible in a conservative scheme

But in practice, that's never what these proposals would actually do huffpost.com/entry/trump-va…
One reason: Their usual fallback/solution for people with pre-existing conditions are "high risk pools," which when tried in the past never came close to doing the job

Here's a primer/refresher from my former colleague @JeffYoung huffpost.com/entry/paul-rya…
The underlying problem here is that in any scheme, guaranteeing insurance is going to require government spending -- and Republican plans are always seeking to cut that spending, in order to finance tax cuts CBO chart on 2017 House ACA repeal bill, showing more than $1T in cuts to federal health care spending
Can certainly argue that conservative solutions are better for the country -- depends on your priorities and philosophy, how you feel about effects of regulation/taxes/spending etc.

But every ACA alternative I've seen = more uninsured, fewer pre-ex condition protections

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More from @CitizenCohn

Jonathan Cohn Profile picture
Sep 16
Trump said it last week, Vance said it yesterday

I'm still stunned they're even *trying* to make this claim (1)
huffpost.com/entry/donald-t…
It's about the Affordable Care Act -- a.k.a., "Obamacare"

You may recall Trump spent years promising to repeal it, then tried desperately during his first year in office to do just that

Had he succeeded, millions would have lost insurance (2) huffpost.com/entry/donald-t…
Now Trump is saying he "saved" the program and on @MeetThePress Sunday Vance doubled down, saying Trump had actually "protected" insurance of people on the program

Seriously? (3) huffpost.com/entry/donald-t…
Read 7 tweets
Jonathan Cohn Profile picture
Nov 28, 2023
Yesterday I wrote about Donald Trump vowing to repeal Obamacare -- and what that would mean for the millions of Americans who depend on it for health insurance (1/x) huffpost.com/entry/donald-t…
Impact of repeal could be especially pronounced among Black and Latino Americans, who have gained disproportionately from ACA coverage gains

Per @ThePlumLineGS here (2/x)
GOP senators didn't sound too interested in revisiting repeal when they spoke to @josephzeballos about it (3/x) semafor.com/article/11/27/…
Read 4 tweets
Jonathan Cohn Profile picture
Jul 2, 2023
Many ways to think about 303, but an underlying question is whether anti-LGBTQ discrimination deserves privileged treatment — ie, legal sanction we don’t give other forms — because people who want to discriminate can cite religious principle or their interpretation of it. (1/x)
I realize this is not what Gorsuch & the majority say they are doing. They say this is about free speech, not religion or sexuality/gender identity.

Not for me to say what justices truly think.

Legal scholars know better than I do what decision will mean in practice. (2/x)
But seems clear a broader debate here, in politics and law, is whether it’s ok to discriminate openly and legally against members of LGBTQ+ community — with some saying answer is yes when people cite their religion as justification. (3/x)
Read 5 tweets
Jonathan Cohn Profile picture
Jun 22, 2023
Pharma is suing to block the new Rx reforms, arguing that price "negotiation" is really just a form of extortion

But the companies can choose not to participate in Medicare, notes @nicholas_bagley -- "it doesn't follow that they've been coerced" (1/x) huffpost.com/entry/drug-ind…
This @hiltzikm column has a great in-depth look at that issue in particular (2/x) latimes.com/business/story…
If you drill down on the program and lawsuits, there's a question about early penalties and whether companies can opt out in time to avoid those

But -- again via @nicholas_bagley -- there are remedies for that short of wiping out the whole thing (3/x) latimes.com/business/story…
Read 12 tweets
Jonathan Cohn Profile picture
Feb 2, 2023
Seems like DeSantis doesn't want to talk about Medicaid expansion and what he's not doing for 2.6M uninsured Floridians.

Three weeks of inquiries to his office, couldn't get a straightforward answer on his position -- or any of my questions. (1/x) huffpost.com/entry/ron-desa…
Could just be me -- staff too busy to deal with a HuffPost reporter, etc.

But it's tough to find recent public comments and DeSantis didn't engage when Democrats raised the issue in the gubernatorial campaign. (2/x) huffpost.com/entry/ron-desa…
My theory? It's about the politics, especially if he's gearing up to run for president. (3/x)
citizencohn.substack.com/p/ron-desantis… Quote from article: Strange, yes, until you consider that h
Read 10 tweets
Jonathan Cohn Profile picture
Jan 31, 2023
2.6M Floridians have no health insurance

Ron DeSantis could do something about that

He hasn't huffpost.com/entry/ron-desa…
More here from @mmfa @MattGertz -- one of few who have picked up on this story mediamatters.org/health-care/ro…
Good column from @jbouie about DeSantis and the parts of his gubernatorial record that don't get a lot of attention nytimes.com/2023/01/24/opi…
Read 4 tweets

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