How Trump Paved the Way for Democrats’ Trillion-Dollar Plans

Plus, Trump calls for an end to surprise medical bills

Trump Calls for an End to Surprise Medical Bills

President Trump said Thursday that he wants Congress to protect Americans from surprise medical expenses — the large, unexpected bills patients sometimes receive after they undergo surgery or get treatment in an emergency room, for services from doctors who are not part of their insurance networks.

“No family should be blindsided by outrageous medical bills,” Trump said at the White House. “This must end. We’re going to hold insurance companies and hospitals totally accountable.”

A recent Kaiser Family Foundation poll found that consumers are concerned about the issue, with 50% of respondents saying that “protecting people from surprise medical bills” should be a top priority for policymakers.

The White House said that patients should not be charged extra for emergency care, when patients typically have no choice in how or by whom they are treated, and that pricing for elective procedures should be fully transparent before any services are provided. Administration officials did not, however, discuss how they would create and enforce such regulations, and Congress is expected to take the lead in developing a comprehensive proposal. Sen. Lamar Alexander (R-TN) said that he expects to send the president a bill in July.

The issue is seen as “one of the most likely areas for bipartisan action on health care this year,” The Hill’s Nathaniel Weixel said.

Lawmakers have been working on a bill that would put an end to surprise bills, although there’s little agreement on how costs could be reallocated. Sen. Bill Cassidy (R-LA) said that creating an arbitration system to address questionable bills has gained support, although that could be a problem for the White House, which has signaled that it doesn’t support that approach.

Kaiser Health News’s Julie Rovner said that the most significant hurdle may be the conflict between insurers and health care providers on the matter. Doctors and hospitals lean toward the arbitration model to settle billing disputes, while insurers prefer clear pricing benchmarks that would avoid billing disputes in the first place. Rovner said that “it's not clear where compromise might be found.”

Trump said that his administration would soon release more details on a broad effort to increase transparency in health care. “We’re going to be announcing something, I think, over the next two weeks that’s going to bring transparency to all of it, and I think in a way it’s going to be as important as the health care bill. It’s going to be really special,” Trump said.

How Trump Paved the Way for Democrats’ Trillion-Dollar Plans

When the incoming Obama administration was looking to put together a stimulus package during the financial crisis a decade ago, the optimal size of the proposal was the subject of considerable debate: Should it be $600 billion? $850 billion? $1.2 trillion? $1.8 trillion?

A trillion-dollar price tag was seen as impossible politically and some Republicans and Democrats in Congress insisted that the cost couldn’t top $800 billion. Congress was “a big constraint,” David Axelrod, a senior Obama adviser, later said. “If we asked for $1.2 trillion, it probably would have created such a case of sticker shock that the system would have locked up there.”

In the end, the 2009 American Recovery and Reinvestment Act totaled $787 billion — a figure that some critics, especially on the left, still contend was far too small, despite the fierce political pushback that any larger package faced.

We’re bringing up that not-too-distant past to note just how much things have changed over the last 10 years. As Time’s Ryan Teague Beckwith points out, “as Democratic contenders gear up for the 2020 primary, they no longer seem afraid of the trillion-dollar price tag.” Democratic candidates have proposed trillion-dollar plans — or multi-trillion-dollar plans — for infrastructure, college tuition and debt, taxes, climate change and health care.

“There was a sense that keeping it below a trillion was a political reality,” Jared Bernstein, who was chief economic adviser to Vice President Joe Biden, told Time. “We can argue about whether that was right or wrong, but it certainly wouldn’t be the case right now.”

Inflation may play a part in that, perhaps making a trillion dollars a less daunting figure than it once was. But the size of some of the country’s problems certainly plays a role as well — and Trumpian politics have also transformed the debate. As a candidate in 2016, Trump talked up the need for a trillion-dollar infrastructure plan. As president, he signed the GOP’s deficit-raising $1.5 trillion tax cuts in 2017.

Teague Beckwith outlines three ways the Trump tax cuts in particular opened the door to other trillion-dollar proposals:

  1. They took some of the bite out of the trillion-dollar figure, making that sum seem reasonable for ambitious presidential proposals.
  2. They made it easier for Democrats to pay for their big ideas by calling for the unpopular tax cuts for the wealthy to be reversed.
  3. They undercut fiscal conservatives’ previous warnings about increasing deficits, exposing the party to criticism for hypocrisy and leaving some on the left arguing that if self-proclaimed budget hawks don’t really care about the deficit when pursuing their agenda, maybe Democrats should do the same.

Jesse Lee, a spokesman for the liberal Center for American Progress Action Fund, tells Teague Beckwith that Trump “defanged the Republican Party’s scolding about government spending and deficits,” adding that, “There is nothing that Democrats are proposing that would be remotely in line with the amount of added deficits [from the Trump tax cuts] compared to the minuscule amount of benefits.”

Read the full piece at Time.

Number of the Day: $9.9 Trillion

A Congressional Budget Office analysis of president Trump’s proposed 2020 budget finds that it would lead to $9.9 trillion in cumulative deficits over 10 years — about $2.7 trillion more than the White House estimated. CBO said most of the difference stems from the White House’s more optimistic economic forecasts, which project annual growth averaging about 3% a year over the next decade, compared to CBO’s forecast of growth averaging less than 2%.

The president’s budget would produce annual deficits averaging 3.8% of GDP from 2020 through 2029, CBO said, about the same level as last year and a full percentage point higher than the White House had estimated. Still, Trump's proposal would see the national debt rise less than current projections, growing to 87% of GDP rather than 92%, CBO said.

Let’s Not Make a Deal? GOP Senators Reportedly Frustrated by Trump’s Chief of Staff

Some Republican senators see acting White House chief of staff Mick Mulvaney as an impediment to reaching deals on important budgetary matters, The Hill’s Alexander Bolton reports. Mulvaney, a former House Freedom Caucus stalwart, is putting a firmly conservative stamp on Trump administration policy, and that may make it harder to reach a bipartisan agreement on spending levels, raise the debt ceiling and avoid a government shutdown in the fall.

“There is a feeling that the Freedom Caucus may be on the wane in the House, but it’s on the ascendency in the West Wing,” one Republican senator told Bolton.

Lawmakers are frustrated about the lack of progress on a disaster relief package and talks to raise the spending caps for next year’s budget. Some see Mulvaney as a prime mover behind White House intransigence on the issues.

The potential $2 trillion infrastructure plan discussed by Trump and Democratic leaders may serve as a case in point, Bolton said. Mulvaney was quick to pour cold water on the lofty proposal, telling The Washington Post, “Is it difficult to pass any infrastructure bill in this environment, let alone a $2 trillion one, in this environment? Absolutely.”

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Space Force Could Cost an Extra $1.9 Billion a Year

The Congressional Budget Office also says that setting up the new Space Force proposed by the Trump administration would involve startup costs ranging from $2 billion to $5 billion and would increase defense expenditures by about $1 billion to $2 billion a year.

Here’s a quick summary of the new CBO analysis of potential Space Force costs, which examined the three organizational structures proposed by the Trump administration and two additional options:

  • A new Space Force department: 5,400 to 7,800 personnel; $1.4 billion to $3.2 billion in startup costs; $1 billion to $1.5 billion in annual costs.
  • A new Space Force service within an existing department: 4,100 to 6,800 personnel; $1.1 billion to $3.0 billion in startup costs; $820 million to $1.3 billion in annual costs.
  • A new Space Force combat command: 400 to 600 personnel; $520 million to $1.0 billion in startup costs; $80 million to $120 million in annual costs.
  • A new Space Force development and acquisition agency: 1,200 to 2,300 personnel; $220 million to $560 million in startup costs; $240 million to $460 million in annual costs.
  • A new Space Force policy directorate: 40 to 300 personnel; less than $10 million in startup costs; $10 million to $60 million in annual costs.

CBO noted that the Trump administration “has provided few details about what the three organizations that it has proposed would look like or how large they would be,” leading to a wide range of cost estimates. In the most extreme scenario, in which Space Force included a new service, a new combat command and a new development and acquisition agency, setup costs could come to $4.7 billion, while operating costs could increase by $1.9 billion per year.

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