“This is comprehensive, commonsense reform that some Fake News clowns are struggling to comprehend,” wrote White House Deputy Press Secretary Kush Desai."
I always read WH statements, just for the amusement of seeing how many insults and lies they include. (I certainly don't expect anything substantive.)
The GOP has been promising their own comprehensive healthcare proposal since the moment the Affordable Care Act was proposed. Does anyone else remember the "listening tour" staged by the charlatan Paul Ryan in Obama's first term, when he promised to deliver a plan for "patient-centered healthcare"? He never delivered anything besides "repeal and replace," which John McCain (RIP) sent down in flames (just like his fighter jet that was shot down).
They've been fighting healthcare legislation since Medicare was proposed (and probably before), except for sabotaging the ACA and attacking reproductive rights.
National Health care is a right not a privilege. A Healthcare plan that covers pre existing conditions, excludes high deductibles and co-pays. Preserves a woman’s right to choose.
Take the insurance companies out of the equation, reverse tax cuts, foreign imperialism, and ice. Force corporations to actually pay taxes. What would happen? A less stressed country, a society organized around common sense.
Dems should change three commas in the ACA and rename it "Trumpcare", and institute a $1000 fine for anyone uttering "ACA" or "Obamacare" in public. The fines would go directly to the QSF. (Qatari Slush Fund)
Trump could claim credit, Republicans could go home and have town halls about trans in sports, and Democrats could gather and tie themselves up in knots about messaging in relative peace.
Another first-rate update, Jonathan. I'm blessed to have very good health insurance, so am not really affected that much by this. But it's a mess, and I appreciate your detailed explanations - even tho I sometimes can't follow all the convolutions.
It's silly, I know, but what struck me most was the sentence that began, "During a briefing call with reporters on Thursday, a White House official speaking anonymously on behalf of the administration said..." Why on earth would a WH official have a briefing call w/ reporters, and do so ANONYMOUSLY??? Guess they'll next start wearing masks when they talk to reporters in person.
“This is comprehensive, commonsense reform that some Fake News clowns…”
There must be a memo or executive order that requires all administration responses to be written by a middle school child. I read a comment like that and conclude these are not serious people. I believe the term for this administration is kakistocracy, government by the least capable.
This President and more importantly, his administration, focuses more intently on far grander projects than inconsequential memes like healthcare. The National Security Strategy provides a much greater impact and aggrandizement than does the cost of blood pressure pills. Tiny Pills or Hemispheric Dominion? Which sounds grander? A lot of endeavor went into the National Security Strategy which sits atop the undergirding principles and foundations of Project 2025. Intimidation and subjugation; first at home and then abroad. Minnesota and Greenland. Then on to Canada. Now that projects power. Blood pressure pills are weak. Hemispheric dominion is Strong. That is where the power and real money lies and both are there for the taking.
On the "Great Healthcare Plan", I have the video version of the president talking up (and describing?) his plan a bit after the plan was released (in a presentation that was supposed to be about a separate Rural Health Initiative):
(You need to listen for quite some time to see the president exposit fully on the "Great Healthcare Plan". He starts of with "Most Favored Nation", and goes on to everything else. Don't forget to hang on, and wait for Dr. Oz to speak! And then, if you listen longer, you can see where the president gets concerned that Lisa Murkowski of Alaska may not vote for his "Great Healthcare Plan.)
This video worries me more than the written presentation. Because it seems to indicate the president thinks he understands more than he understands. He understands not a thing. He has made this clear from his numerous statements, including those in the video.
(We have enough trouble relying on Congressional Republicans and their advisors, who also may understand not a thing, as I have indicated in prior comments on Cohn:
there are real questions about whether the Republicans in Congress, and their advisors, have the necessary intellectual skill to come up with an effective plan. (Let alone the will! Let alone the constant deceptive tricks that the Republicans are always playing on everyone around healthcare.
With all of this, we don't need the president forcing his ideas in on this!)
--
If you didn't get enough of Trump speaking on the new great plan, I also have the president talking up the coming great plan a day or so before it was released, at the Detroit Economic Club. (It's less comprehensive. If you want just the more comprehensive version, and especially if you have a hankering to see Dr. Oz, I would go with the first video.)
Norm - always appreciate your follow-ups & observations on this topic. Gotta add, when you say "This video worries me... it seems to indicate the president thinks he understands more than he understands..." - yes, one could almost stretch toward that conclusion 😉
🎼It takes a worried man to sing a worried song... 🎼
I don't understand why the insurance scammers haven't come up with a worthless trump branded product that they can sell to trump and he can sell to his base that will get trump off the hook for coming up with a serious health policy and put money in his pocket. His folks sell summary execution as great righteous fun so surely they can sell worthless health insurance. It will take his base a while to realize it is a scam and even longer to admit it. He might even be dead by then. Anything anyone says against it will be branded the lies of a terrorist traitor.
For my money, the German plan, similar to Gov. George Romney’s, is the way to go. It gives people personal responsibility and rids employers of administration costs, both should garner GOP support. It also covers everybody. Yes, some will need a gov’t policy, but to my way of thinking it’s a solid plan that both parties can claim victory.
I feel the need to emphasize that we have to watch out, everywhere, even where we least expect it, for Republican trickery on healthcare. As they try to take us fully backwards.
I have one such case within a comment here today, https://www.thebulwark.com/p/trump-health-care-not-great-not-plan/comment/201522720 , where I indicate that the effect on what people have to pay for ACA health insurance of the "funding of Cost-Sharing-Reductions" (in the Trump outline and elsewhere) is the opposite of what the Republicans deceptive wording indicates.
The deceptive wording is all over the place.
I caught another case in a report from the Manhattan Institute on fiscal policy by a Jessica Reidl and that was referenced by Biden's Chief Economic advisor Jared Bernstein.
Now, Mr. Bernstein did not say he was endorsing everything in the paper, and he even had expressed objection to something on health policy in it.
But still, I feel a need to point out that within that paper are apparent recommendations, rather covert and with propagandistic language, designed to weaken and destroy the ACA.
From the Reidl report:
"Congress should first address the 90% long-term federal reimbursement rate for the newly eligible population of nondisabled, working-age adults with higher incomes that was implemented as part of the Affordable Care Act (ACA) in 2014. States should continue to be allowed to include these newly added adults in their Medicaid programs; but no rational explanation exists for Washington subsidizing nondisabled, higher-earning, working-age adults on Medicaid with a much higher reimbursement rate than children, the elderly, and the disabled. Congress should repeal this higher reimbursement rate."
(Note that, as part of the ACA legislation, states were encouraged to expand Medicaid, and thus include people from below 138% of Federal Poverty Level (FPL) without asset restriction, and above the dirt-poor in both income and assets of traditional pre-ACA Medicaid, by providing a 90% federal reimbursement for those newly-covered (expanded Medicaid) people. Currently, 40 states have expanded. https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/ It was 30 at ACA outset in 2014.)
Numerous states will stop being part of the expansion if they have to pay 50% of medical expenses, rather than 10%, for the expansion population! (Thus leaving lots of people: people 100% FPL down to above dirt-poor in both income and assets with no coverage. 100% is not a mistake. Rather than 138% is due to an ACA detail I will leave out.)
Further, if we do want the ACA to continue, and in fact be improved to eventually take us up to 100% coverage like the rest of the developed world, Ms. Reidl's plan requires the states to pick up the funding not supplied by the federal government. I don't see passing the financial problem onto the states as any kind of solution!
Otherwise, note with the ACA, we have substantial subsidies to people with on-exchange plans, which are needed, and which are paid for by the federal government only. I imagine she and her other colleagues will soon attempt to take apart on-exchange ACA with the same propagandistic sophistry as she has there "but no rational explanation exists for Washington subsidizing nondisabled, higher-earning, working-age adults on Medicaid with a much higher reimbursement rate than children, the elderly, and the disabled."
(The last bit of quoted text is a standard Republican manipulation technique. It's also being used to justify not extending the expanded subsidies, and keeping the 400% FPL "subsidy cliff", which is the thing that has people with incomes of say $88,000 a year having their premiums jump to $40,000 a year for the cheapest plan from $6,000 a year--say a 62 year old couple in Wyoming is one such case. Republican pols have framed this as "why should poor working-class people living paycheck to paycheck have to pay taxes to subsidize a retired person with an income of $88,000 a year? Obvious propagandistic framing, since so much money has been moved from everyone to high earners and the wealthy by Republicans with the recent tax-cut extension, and is being left out of the framing.)
1. "Tax Favored Spending Accounts" a.k.a. Healthcare or Flexible Spending Accounts under current law are owned by employers. These accounts cannot be applied to major medical expenses incurred by those who are not covered by an employer program, Medicare, or Medicaid. Those who use an HSA/FSA must spend the full amount they deposit by the end of the federal fiscal year, when the remainder in their account will be recovered by the federal agency that administers the program.
2. There is no medical marketplace in the U.S. Try to find and compare prices between physicians, imaging centers, radiologists, hospitals, ambulance companies, rehabilitative services, pharmaceutical providers, etc.
3. "Cost Sharing Reductions" depend on the manipulation of formulas incorporated in the ACA, thr law that House and Senate Republicans abhor.
This project promoted by the Felonious Oath-Breaker constitutes a felony attacking U.S. citizens.
Don - re: your #2, I must disagree. It's WORSE that you mention 😉
There have been proposals to develop cost info web sites but even if such info were readily available, consider how making a health care purchase differs from buying, say a toaster or a new car. If I want an aortic valve replacement, there may be no vendor in my local area & I can't order it online w/free shipping. Now I have to factor in costs for travel (to where?) and follow-up care post-surgery. It's not just one "item" I'm pricing, and not every patient has (or can even predict) the same aftercare requirements (e.g. a few days after hospital discharge I experienced congestive heart failure requiring my 1st ambulance ride, but not every patient needs to price that in).
Now let's consider that moment when the telehealth nurse told us, "he needs to go to the ER immediately; call 911, don't attempt to drive" - in a wee bit of stress now, along with the symptoms of CHF that led me to call her, am I to log into the web, then search & find my chosen treatment location to tell the ambulance team? ...only to have them say, "nah, we have a 5 mile limit so there's only 1 ER we'll go to."
TBH, many of us don't spend much time researching the ideal toaster to fit our predicted needs. Maybe a little more time looking at a new car purchase cuz of the cost. But getting medical care really often doesn't lend itself to the model of "competition for consumers informed with complete information." Any plan that doesn't start from this reality is peddling unicorns & magic amulets
HSA's do not require you to spend it all by the end of the year. It is more like a health related 401K that you can take with you when you leave a job or retire.
Well , not exactly .... my ld employer has switched carriers many times , and the rules keep changing . It's not much money but I cant access it to pay for dental now that I am retired . Thank goodness I didnt put the money for medicare supplement in there . It's been many years and many hours on the phone . Other retirees form this employer , same issue
Trump doesn't give a crap about healthcare (a direct extension of his not giving a crap about people). He certainly knows how to lean on R politicians when it suits him -- witness his recent successful strong arming of Hawley and Young on the Venezuela war powers resolution. Basically, Trump puts more energy in one Truth Social rant than in all his healthcare concepts/plans (*eyeroll*) combined. Mark Cuban has already done more to concretely impact drug prices for people than Trump ever will
To be fair to Todd Young, he cares more about Trump bleating online about him than he does about the needs of Hoosiers & the country. Given that, one can understand where the big guy puts his efforts
Neither Trump nor Republicans want healthcare plans. Cutting $1 trillion from Medicaid, no extension on ACA subsidies. Republicans ran on repealing the ACA and finally missed it by one vote. Republicans asked us to trust them to deliver something better and cheaper.
Blaming Trump for no healthcare plan is necessary because he is full of crap. But Republicans opposed care plans first. A lot of what Trump has done Republicans would have done anyway. Like tax cuts for the wealthy and taking healthcare plans away from people and families.
“This is comprehensive, commonsense reform that some Fake News clowns are struggling to comprehend,” wrote White House Deputy Press Secretary Kush Desai."
I always read WH statements, just for the amusement of seeing how many insults and lies they include. (I certainly don't expect anything substantive.)
The GOP has been promising their own comprehensive healthcare proposal since the moment the Affordable Care Act was proposed. Does anyone else remember the "listening tour" staged by the charlatan Paul Ryan in Obama's first term, when he promised to deliver a plan for "patient-centered healthcare"? He never delivered anything besides "repeal and replace," which John McCain (RIP) sent down in flames (just like his fighter jet that was shot down).
They've been fighting healthcare legislation since Medicare was proposed (and probably before), except for sabotaging the ACA and attacking reproductive rights.
Even DJT's concept of an idea of a plan is shit. Expect anything different?
National Health care is a right not a privilege. A Healthcare plan that covers pre existing conditions, excludes high deductibles and co-pays. Preserves a woman’s right to choose.
Take the insurance companies out of the equation, reverse tax cuts, foreign imperialism, and ice. Force corporations to actually pay taxes. What would happen? A less stressed country, a society organized around common sense.
Dems should change three commas in the ACA and rename it "Trumpcare", and institute a $1000 fine for anyone uttering "ACA" or "Obamacare" in public. The fines would go directly to the QSF. (Qatari Slush Fund)
Trump could claim credit, Republicans could go home and have town halls about trans in sports, and Democrats could gather and tie themselves up in knots about messaging in relative peace.
I hate to "like" this but it sure sounds accurate.
Another first-rate update, Jonathan. I'm blessed to have very good health insurance, so am not really affected that much by this. But it's a mess, and I appreciate your detailed explanations - even tho I sometimes can't follow all the convolutions.
It's silly, I know, but what struck me most was the sentence that began, "During a briefing call with reporters on Thursday, a White House official speaking anonymously on behalf of the administration said..." Why on earth would a WH official have a briefing call w/ reporters, and do so ANONYMOUSLY??? Guess they'll next start wearing masks when they talk to reporters in person.
Or bags
“This is comprehensive, commonsense reform that some Fake News clowns…”
There must be a memo or executive order that requires all administration responses to be written by a middle school child. I read a comment like that and conclude these are not serious people. I believe the term for this administration is kakistocracy, government by the least capable.
This President and more importantly, his administration, focuses more intently on far grander projects than inconsequential memes like healthcare. The National Security Strategy provides a much greater impact and aggrandizement than does the cost of blood pressure pills. Tiny Pills or Hemispheric Dominion? Which sounds grander? A lot of endeavor went into the National Security Strategy which sits atop the undergirding principles and foundations of Project 2025. Intimidation and subjugation; first at home and then abroad. Minnesota and Greenland. Then on to Canada. Now that projects power. Blood pressure pills are weak. Hemispheric dominion is Strong. That is where the power and real money lies and both are there for the taking.
On the "Great Healthcare Plan", I have the video version of the president talking up (and describing?) his plan a bit after the plan was released (in a presentation that was supposed to be about a separate Rural Health Initiative):
https://www.youtube.com/live/tcjPj0iJvYs?t=1405s
(You need to listen for quite some time to see the president exposit fully on the "Great Healthcare Plan". He starts of with "Most Favored Nation", and goes on to everything else. Don't forget to hang on, and wait for Dr. Oz to speak! And then, if you listen longer, you can see where the president gets concerned that Lisa Murkowski of Alaska may not vote for his "Great Healthcare Plan.)
This video worries me more than the written presentation. Because it seems to indicate the president thinks he understands more than he understands. He understands not a thing. He has made this clear from his numerous statements, including those in the video.
(We have enough trouble relying on Congressional Republicans and their advisors, who also may understand not a thing, as I have indicated in prior comments on Cohn:
https://www.thebulwark.com/p/obamacare-aca-subsidies-extension-moreno-jeffries/comment/198315391
https://www.thebulwark.com/p/obamacare-aca-subsidies-extension-moreno-jeffries/comment/198307226
and elsewhere,
https://normspier828307.substack.com/p/senate-republican-leader-john-thune
https://normspier828307.substack.com/p/who-are-the-economic-advisors-who-5ef
https://normspier828307.substack.com/p/who-are-the-economic-advisors-who
there are real questions about whether the Republicans in Congress, and their advisors, have the necessary intellectual skill to come up with an effective plan. (Let alone the will! Let alone the constant deceptive tricks that the Republicans are always playing on everyone around healthcare.
With all of this, we don't need the president forcing his ideas in on this!)
--
If you didn't get enough of Trump speaking on the new great plan, I also have the president talking up the coming great plan a day or so before it was released, at the Detroit Economic Club. (It's less comprehensive. If you want just the more comprehensive version, and especially if you have a hankering to see Dr. Oz, I would go with the first video.)
https://www.youtube.com/live/lxHFFOjBq2I?t=2728s
Norm - always appreciate your follow-ups & observations on this topic. Gotta add, when you say "This video worries me... it seems to indicate the president thinks he understands more than he understands..." - yes, one could almost stretch toward that conclusion 😉
🎼It takes a worried man to sing a worried song... 🎼
After all he knows the best words, is a genius playing 3 dimensional chess and knows more than anybody else. :)
Just rebrand the ACA as “Trumpcare” and watch Republican opposition melt away.
I don't understand why the insurance scammers haven't come up with a worthless trump branded product that they can sell to trump and he can sell to his base that will get trump off the hook for coming up with a serious health policy and put money in his pocket. His folks sell summary execution as great righteous fun so surely they can sell worthless health insurance. It will take his base a while to realize it is a scam and even longer to admit it. He might even be dead by then. Anything anyone says against it will be branded the lies of a terrorist traitor.
Terry - given Kevin Hassett recent dangling of T-branded credit cards with 10% interest cap (https://www.cnbc.com/2026/01/16/white-house-hassett-trump-cards-credit-card-battle.html) you're likely onto something Huuuge
For my money, the German plan, similar to Gov. George Romney’s, is the way to go. It gives people personal responsibility and rids employers of administration costs, both should garner GOP support. It also covers everybody. Yes, some will need a gov’t policy, but to my way of thinking it’s a solid plan that both parties can claim victory.
The deal making compromise is, keep the subsidies and rename it Trump Care. I bet trump takes this deal today
I feel the need to emphasize that we have to watch out, everywhere, even where we least expect it, for Republican trickery on healthcare. As they try to take us fully backwards.
I have one such case within a comment here today, https://www.thebulwark.com/p/trump-health-care-not-great-not-plan/comment/201522720 , where I indicate that the effect on what people have to pay for ACA health insurance of the "funding of Cost-Sharing-Reductions" (in the Trump outline and elsewhere) is the opposite of what the Republicans deceptive wording indicates.
The deceptive wording is all over the place.
I caught another case in a report from the Manhattan Institute on fiscal policy by a Jessica Reidl and that was referenced by Biden's Chief Economic advisor Jared Bernstein.
(Reidl report: https://manhattan.institute/article/a-comprehensive-federal-budget-plan-to-avert-a-debt-crisis-2024#notes
Jared referencing it: https://econjared.substack.com/p/americas-fiscal-outlook-takes-its )
Now, Mr. Bernstein did not say he was endorsing everything in the paper, and he even had expressed objection to something on health policy in it.
But still, I feel a need to point out that within that paper are apparent recommendations, rather covert and with propagandistic language, designed to weaken and destroy the ACA.
From the Reidl report:
"Congress should first address the 90% long-term federal reimbursement rate for the newly eligible population of nondisabled, working-age adults with higher incomes that was implemented as part of the Affordable Care Act (ACA) in 2014. States should continue to be allowed to include these newly added adults in their Medicaid programs; but no rational explanation exists for Washington subsidizing nondisabled, higher-earning, working-age adults on Medicaid with a much higher reimbursement rate than children, the elderly, and the disabled. Congress should repeal this higher reimbursement rate."
(Note that, as part of the ACA legislation, states were encouraged to expand Medicaid, and thus include people from below 138% of Federal Poverty Level (FPL) without asset restriction, and above the dirt-poor in both income and assets of traditional pre-ACA Medicaid, by providing a 90% federal reimbursement for those newly-covered (expanded Medicaid) people. Currently, 40 states have expanded. https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/ It was 30 at ACA outset in 2014.)
Numerous states will stop being part of the expansion if they have to pay 50% of medical expenses, rather than 10%, for the expansion population! (Thus leaving lots of people: people 100% FPL down to above dirt-poor in both income and assets with no coverage. 100% is not a mistake. Rather than 138% is due to an ACA detail I will leave out.)
Further, if we do want the ACA to continue, and in fact be improved to eventually take us up to 100% coverage like the rest of the developed world, Ms. Reidl's plan requires the states to pick up the funding not supplied by the federal government. I don't see passing the financial problem onto the states as any kind of solution!
Otherwise, note with the ACA, we have substantial subsidies to people with on-exchange plans, which are needed, and which are paid for by the federal government only. I imagine she and her other colleagues will soon attempt to take apart on-exchange ACA with the same propagandistic sophistry as she has there "but no rational explanation exists for Washington subsidizing nondisabled, higher-earning, working-age adults on Medicaid with a much higher reimbursement rate than children, the elderly, and the disabled."
(The last bit of quoted text is a standard Republican manipulation technique. It's also being used to justify not extending the expanded subsidies, and keeping the 400% FPL "subsidy cliff", which is the thing that has people with incomes of say $88,000 a year having their premiums jump to $40,000 a year for the cheapest plan from $6,000 a year--say a 62 year old couple in Wyoming is one such case. Republican pols have framed this as "why should poor working-class people living paycheck to paycheck have to pay taxes to subsidize a retired person with an income of $88,000 a year? Obvious propagandistic framing, since so much money has been moved from everyone to high earners and the wealthy by Republicans with the recent tax-cut extension, and is being left out of the framing.)
1. "Tax Favored Spending Accounts" a.k.a. Healthcare or Flexible Spending Accounts under current law are owned by employers. These accounts cannot be applied to major medical expenses incurred by those who are not covered by an employer program, Medicare, or Medicaid. Those who use an HSA/FSA must spend the full amount they deposit by the end of the federal fiscal year, when the remainder in their account will be recovered by the federal agency that administers the program.
2. There is no medical marketplace in the U.S. Try to find and compare prices between physicians, imaging centers, radiologists, hospitals, ambulance companies, rehabilitative services, pharmaceutical providers, etc.
3. "Cost Sharing Reductions" depend on the manipulation of formulas incorporated in the ACA, thr law that House and Senate Republicans abhor.
This project promoted by the Felonious Oath-Breaker constitutes a felony attacking U.S. citizens.
Don - re: your #2, I must disagree. It's WORSE that you mention 😉
There have been proposals to develop cost info web sites but even if such info were readily available, consider how making a health care purchase differs from buying, say a toaster or a new car. If I want an aortic valve replacement, there may be no vendor in my local area & I can't order it online w/free shipping. Now I have to factor in costs for travel (to where?) and follow-up care post-surgery. It's not just one "item" I'm pricing, and not every patient has (or can even predict) the same aftercare requirements (e.g. a few days after hospital discharge I experienced congestive heart failure requiring my 1st ambulance ride, but not every patient needs to price that in).
Now let's consider that moment when the telehealth nurse told us, "he needs to go to the ER immediately; call 911, don't attempt to drive" - in a wee bit of stress now, along with the symptoms of CHF that led me to call her, am I to log into the web, then search & find my chosen treatment location to tell the ambulance team? ...only to have them say, "nah, we have a 5 mile limit so there's only 1 ER we'll go to."
TBH, many of us don't spend much time researching the ideal toaster to fit our predicted needs. Maybe a little more time looking at a new car purchase cuz of the cost. But getting medical care really often doesn't lend itself to the model of "competition for consumers informed with complete information." Any plan that doesn't start from this reality is peddling unicorns & magic amulets
HSA's do not require you to spend it all by the end of the year. It is more like a health related 401K that you can take with you when you leave a job or retire.
Well , not exactly .... my ld employer has switched carriers many times , and the rules keep changing . It's not much money but I cant access it to pay for dental now that I am retired . Thank goodness I didnt put the money for medicare supplement in there . It's been many years and many hours on the phone . Other retirees form this employer , same issue
Okay, I sit corrected.
Trump doesn't give a crap about healthcare (a direct extension of his not giving a crap about people). He certainly knows how to lean on R politicians when it suits him -- witness his recent successful strong arming of Hawley and Young on the Venezuela war powers resolution. Basically, Trump puts more energy in one Truth Social rant than in all his healthcare concepts/plans (*eyeroll*) combined. Mark Cuban has already done more to concretely impact drug prices for people than Trump ever will
To be fair to Todd Young, he cares more about Trump bleating online about him than he does about the needs of Hoosiers & the country. Given that, one can understand where the big guy puts his efforts
Neither Trump nor Republicans want healthcare plans. Cutting $1 trillion from Medicaid, no extension on ACA subsidies. Republicans ran on repealing the ACA and finally missed it by one vote. Republicans asked us to trust them to deliver something better and cheaper.
Blaming Trump for no healthcare plan is necessary because he is full of crap. But Republicans opposed care plans first. A lot of what Trump has done Republicans would have done anyway. Like tax cuts for the wealthy and taking healthcare plans away from people and families.
see Project 2025 for details of the blueprint which was prepared no matter who the R candidate might be