Donald Trump has repeatedly assured the American people that their health-care system will collapse on his watch. In many instances, the president has framed this claim as a matter-of-fact assessment of Obamacare’s incurable flaws — in others, as a promise to kill the law by any means necessary.
In early April, Trump sounded the latter note. In an interview with The Wall Street Journal, the president suggested that he would cease paying out cost-sharing reductions — subsidies to insurers that defray the cost of covering low-income Obamacare enrollees — so as to engineer a crisis in the private insurance market, and, thus, generate more support for repealing Barack Obama’s signature law.
“I don’t want people to get hurt,” Trump told the paper. “What I think should happen — and will happen — is the Democrats will start calling me and negotiating.”
The president never shot his hostage. But pointing a gun in its direction may have been good enough.
By threatening to stop paying out those so-called cost-sharing reductions — while also threatening not to enforce penalties on those go without insurance — the White House sowed uncertainty that chased insurers out of Obamacare.
In mid-April, several of America’s largest insurance companies descended on Washington to seek the White House’s assurance that Trump’s rhetoric about withholding the subsidies was just a bluff. Seema Verma, Trump’s head of Medicare and Medicaid Services, informed the insurers that it could be a bluff — if they agreed to publicly support the president’s health-care bill.
The insurers found little comfort in this exchange. Nor did Trumpcare’s sudden revival calm their nerves. To protect themselves from a diverse array of very-bad-case scenarios, many jacked up their premiums and wound down their participation in the Affordable Care Act.
Over the past week, the number of counties with no plans signed up to sell Obamacare has doubled. Which is to say: There are now 38,000 ACA enrollees, dispersed across 47 counties, who have subsidies to buy insurance — but no one to buy it from. Those figures are likely to increase as we move closer to the June 21 deadline for insurers to declare whether the intend to participate in Obamacare next year.
This development will hurt nonaffluent Trump voters in rural America. And it may well hurt the GOP’s political fortunes in 2018 — voters tend to blame the party in power for bad things that happen on their watch. But in the immediate term, the administration’s various acts of sabotage do seem to be buoying the prospects of Obamacare repeal.
The collapse of the ACA exchanges in Iowa earned Trumpcare at least one “moderate” Republican vote in the House last month, according to Politico:
The last insurer on Iowa’s exchange pulled out the day before the vote, leaving thousands without an option to purchase insurance. That troubled Rep. David Young (R-Iowa.), who had remained opposed to the measure throughout the talks. The vulnerable Republican felt compelled to vote for a replacement in light of his home-state situation.
In the last seven days, as the consequences of White House sabotage have rippled throughout the country, Senate Republicans (reportedly) made a breakthrough on Obamacare repeal.
A new report from Vox’s Sarah Kliff suggests these facts may be related:
Whenever a health insurance plan quits Obamacare, I usually receive an email from the Health and Human Services press office arguing that this is all the more reason Congress needs to repeal Obamacare. This is the statement that spokesperson Alleigh Marre sent out when Anthem quit the Ohio marketplace last Tuesday (bolding my own):
This news is heartbreaking for the millions of Ohioans who depend on access to affordable, high-quality healthcare, and this is a stark reminder that Obamacare is collapsing. Now is the time to advance real healthcare reform that empowers individuals and families with the choices and resources they need to buy a plan that meets their healthcare needs without breaking their budgets. The American people can’t afford to wait any longer.
On the day the House passed Trumpcare, Ohio senator Rob Portman vowed to oppose any bill that hurt his state’s Medicaid enrollees so badly. “I’ve already made clear that I don’t support the House bill as currently constructed,” Portman said, “because I continue to have concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population.”
This week, Portman made his peace with ending Medicaid expansion — so long as it’s wound down over seven years, instead of three. This change does more to protect Senate Republicans from political blowback than low-income Ohioans from the loss of their insurance.
It’s entirely possible that Portman would have fallen in line with his party’s leadership, even if his state’s Obamacare marketplaces were thriving. But the fact they aren’t will surely make easier for him to justify his vote.
Meanwhile, 14 Senate Republicans are imploring the administration to commit another act of sabotage. In a recent letter to Health Secretary Tom Price, the lawmakers called for the abolition of an Obama-era regulation that restricts access to skimpy, short-term insurance plans. These low-cost, low-coverage plans provide healthy people with a means of evading Obamacare’s individual mandate without purchasing insurance over the law’s exchanges. The likely effect of the Senate GOP’s request would be the further destabilization of the private insurance market, as the pool of people seeking coverage through the Obamacare marketplaces would grow even sicker.
As of this writing, the GOP appears poised to pass its heinously unpopular plan to finance a tax cut for the rich by throwing millions of poor people off of their health insurance. If their emerging strategy of “sabotage, secrecy, and sudden repeal” works, the president will deserve a measure of credit for his ruthlessness.
But others will also deserve recognition. The authors of Obamacare bear some responsibility. The ACA has achieved most of its admirable ambitions. But by relying on private companies to voluntarily participate on the exchanges — and refusing to impose a more draconian penalty on the willfully uninsured — Democrats made their law vulnerable to vandals.
Speaking of vandals, congressional Republicans, of course, merit special commendation: It was their successful 2014 lawsuit that provided Trump with the power to cancel cost-sharing reductions at will.
And last, but decidedly not least, credit must be given to every mainstream politician and publication that ever assured the American people their nation had two normal, equally legitimate parties — ones united in their commitment to serving the public interest, even if they disagreed about how, precisely, to do so.
