During the presidential debate on Tuesday, Donald Trump was pressed on the details of his plan to repeal Obamacare and replace it with something “better.” The question should’ve been a softball. After all, Mr. Trump has been promising the American people a plan for nine years, so he’s had time to prepare. His answer? After ducking and weaving, he came up with: “I have concepts of a plan.” Uh, that’s not a plan.
Plans translate values into action. They test the quality of the ideas and the seriousness of the people advancing them. Plans reveal for whom candidates will fight and how effective they are likely to be. And in a presidential race, if either party’s nominee is asked about his or her plans for something as fundamental as health care, voters should get a straight answer.
The problem is not that Mr. Trump can’t think up a way to put his values into action. The problem is that when he and other Republican leaders produce plans with actual details, they horrify the American people.
Mr. Trump’s health care values have been on full display for years. In 2017, Republicans controlled Congress, and their first major legislative undertaking was a bill to repeal the Affordable Care Act. Every time they drafted something, independent experts would point out that their plan would toss tens of millions of people off their health insurance, jack up premium costs and slash benefits for those with ongoing health problems.
After months of wrangling, Mr. Trump and Republican lawmakers voted a bill through the House to repeal the A.C.A. That night, Mr. Trump hosted a party at the White House to celebrate their big step toward taking away health care from millions of people.
A.C.A. repeal then moved to the Senate. Republicans had the majority, so if they all stuck with Mr. Trump, the A.C.A. would die. As senators gathered to vote, nearly all of the Democrats — including Kamala Harris, then a senator from California — remained standing, too anxious even to sit down. We murmured stories about who would be affected by this vote: the uncle who had cancer and would lose coverage, the kid diagnosed with a heart anomaly whose parents wouldn’t be able to find new insurance, the college students who would just go without coverage and hope they didn’t fall on ice or get in a car accident. We felt the weight of people’s lives on the line.
As the votes rolled in, we could see that Mr. Trump was on track to win. Our last hope was John McCain. When Mr. McCain put his thumb down, he saved the Affordable Care Act. That one vote made the difference for millions of Americans between losing and keeping their health care coverage.
Over time, people have decided that they like the access to health care that the A.C.A. gives them. Republican losses in 2018 and 2020 are often attributed in part to Mr. Trump’s efforts to take away the A.C.A. Republican members of Congress have since smartened up and stopped talking about repeal.
Mr. Trump, however, was unbowed. He doubled down on getting rid of the A.C.A., saying last year that it “sucks,” and that Republicans should “never give up” on repealing it.
But at the debate, Mr. Trump displayed a new strategy. He seems to realize that his health-care plans are deeply unpopular, so he simply doesn’t talk about them. Thus, after nine years of railing against the A.C.A. and trying mightily to repeal it, he has moved to “concepts of a plan,” without a single detail that anyone can pin him down on.
The new strategy might have worked — except Mr. Trump’s right-wing buddies have already laid out the plans. No need for concepts. Project 2025 has 920 pages translating Republican values into detailed action plans, including on health care: Repeal the A.C.A. Cut Medicare benefits. End $35 insulin. Stop Medicare drug price negotiations. Cut health-care access for poor families. Restrict contraceptive care. Jeopardize access to I.V.F. Ban medication abortion.
As Project 2025’s favorability plummets, Mr. Trump is once again scrambling. “I have nothing to do with Project 2025,” he claimed at the debate. “I’m not going to read it.” But it was written by many members of Mr. Trump’s former administration and over 250 of the policies in the plan match his past or current policy proposals.
While Mr. Trump dances around “concepts of a plan” that will rip away health care access for millions, Vice President Harris and Democrats in Congress are committed to real improvements. We’ve already delivered Medicare price negotiation on 10 widely used drugs, capped monthly insulin costs at $35 for seniors and limited out-of-pocket spending for prescription drugs under Medicare to $2,000 per year. In Ms. Harris’s first big economic speech last month, she announced she’d build on these wins, extending access to $35-per-month insulin to all Americans and allowing Medicare to negotiate prices for even more drugs. She has also called for ensuring abortion access nationwide.
A presidential campaign should be, in part, a debate of ideas, and it’s not only reasonable but also commendable that people want to know what a person would do in office. That’s why Ms. Harris has given major policy addresses and released a slew of policy proposals, including a plan this week focusing on rural America. Mr. Trump should be held to the same expectation. The reason there isn’t more outcry over his debate answer is that we all know his actual plan: Get elected, and then do whatever the far right wants with the A.C.A. But saying that out loud wouldn’t go over well at a debate.
As Ms. Harris has pointed out, Mr. Trump is not a serious man, and “concepts of a plan” is a silly dodge. But, as she also noted, a Trump presidency would have profoundly serious consequences — including life-or-death outcomes for millions of people who could lose access to health care. When voters mark their ballots, they may consider that a man with Mr. Trump’s record cannot be trusted with our families’ health care.
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