Donald Trump
Credit: Michael Vadon/Flickr

Do you remember that facepalm moment during the Republican debate when Donald Trump couldn’t talk about anything related to health care reform other than getting rid of those lines around the states?

It was clear that he knew nothing about what Obamacare actually does, but had picked up the Republican talking point about selling plans across state lines and ran with it.

Over the last week it has become clear that the president has now incorporated some new words from the Republican talking points on health care: block grants.

Monday, October 16th

So I think we will have a short-term fix with Republicans and Democrats getting together and after that have a successful vote. Because as you know, we were one vote short and I think we have the votes right now, whether it’s through block-granting the money back to the states. It’s a smaller form of government that can be more individually sensitive. That will happen fairly shortly.

Tuesday, October 17th

PRESIDENT TRUMP: We feel we have the votes, and as soon as we’re finished with taxes, John — we really feel we have the votes to get block grants into the states, where the states can much better manage this money and much better take care of the people, rather than the federal government. The state block grants — we’ll do massive block grants into the various states so that the states can run the program…

Q So is Graham-Cassidy still the plan, sir?

PRESIDENT TRUMP: Yeah, essentially that would be the plan. Yes, block grants.

Wednesday, October 18th (in a call to Sen. Lamar Alexander)

“[Trump] called me to say that he wanted to be encouraging,” Alexander said. “He intends to review [the bipartisan fix Alexander developed with Sen. Murray] carefully to see if he wants to add anything to it. And number three, he’s still for block grants, but sometime later.”

It sure looks like “block grants” are playing the same role for the president right now that “state lines” did during the primary. It is a concept he seems to have just learned and is now using to pretend that he knows something about health care policy. Honestly, it reminds me of a toddler who is in the process of expanding their vocabulary. Once they pick up a new word, they say it over and over and over again.

Perhaps I’m wrong. Maybe Trump has taken a deep dive into the various Republican proposals and thoughtfully summed up their intentions with the term “block grant.” That would be a first, wouldn’t it? The best evidence that is not likely the case is that, as Paul Waldman notes, his flip-flopping on the Alexander—Murray compromise indicates that he still doesn’t have a clue about the complexities of health care reform.

When you try to interpret the president’s shifting positions — and figure out how this is all going to end — there are a few things you have to keep in mind. First, it’s wise to assume that he has no idea how any provision of this agreement or the ACA itself actually works, and that will not change. For instance, he seems to have convinced himself that cost-sharing reductions are like an extra bonus given to insurance companies that they’ll just use to pad their profits. “That money is going to insurance companies to lift up their stock price,” he has said, when in fact the money is basically passed through the insurers to provide lower co-payments and deductibles for people with low incomes. He hasn’t bothered to learn what the law does, and he certainly isn’t going to quickly get up to speed on new proposals to provide technical fixes.

One way to prove me wrong about whether or not Trump understands the impact of block grants would be for some enterprising White House correspondent to ask the president to lay out his thoughts about what block grants would cover, how they would work, and what they would achieve. The very predictable response of a diatribe about just how dead Obamacare is right now would prove my point.

Nancy LeTourneau

Follow Nancy on Twitter @Smartypants60.