At his remarks today, which included his now-signature touch of watching as his underlings lavish him with displays of obsequious praise, President Trump announced yet another triumph. His gigantic tax cuts and reform law — the Largest in History* — also included a repeal of the individual mandate, and had therefore repealed Obamacare:
Almost none of this is true. Indeed, it reveals the opposite. Trump recognizes that he has no chance to repeal Obamacare, so he is instead pretending to have killed the law that his base loathes (but which the country as a whole likes quite a bit).
Most of Obamacare remains in place. That includes such things as reforms that have helped hold down medical inflation, the expansion of Medicaid to cover the poor, subsidies for individuals to buy insurance, and regulations to prevent insurers from cherry-picking the healthy and excluding the sick. “When the individual mandate is being repealed, that means Obamacare is being repealed. Because they get their money from the individual mandate,” Trump “explains.” It is possible he thinks this is true. It isn’t. The law is primarily financed by other taxes.
It is correct that repealing the individual mandate will impair the effectiveness of the marketplaces that sell insurance to people who can’t get coverage through their employer. That will make premiums more expensive, and possibly drive insurers out of some markets. States that want to have a highly functioning marketplace will be able to impose a state-level mandate, though, an outcome that could make insurance cheaper in blue states than red ones.
What’s more, the elimination of the individual mandate closes off any chance Republicans had to replace or even scale back Obamacare. Repealing the mandate was the linchpin of the overall repeal effort. The mandate is the law’s most unpopular element, and repealing it saves a lot of money (because, the Congressional Budget Office assumes, it encouraged people to sign up for coverage, which is subsidized by the government). Republicans had used the savings to help finance their replacement plans for Obamacare.
Now that they’ve instead used those savings to finance tax cuts for corporations, they can’t use it again for a replacement. That makes designing a replacement all the more difficult. What’s more, with Democrat Doug Jones poised to replace Republican Luther Strange, the Republican margin in the Senate has fallen by another seat when they already lacked the votes to pass anything.
Trump’s triumphant remarks grew a little awkward when he proceeded to explain what he would do after celebrating the alleged death of Obamacare. “We have essentially repealed Obamacare, and will come up with something that’s much better, whether it’s block grants or whether it’s taking what we have and doing something terrific,” he promised.
Ay, there’s the rub. Trump couldn’t come up with anything terrific to replace Obamacare, or even anything adequate. His old plan, which he broadcast repeatedly as evidence of his genius, was to cripple the law and blame Democrats, who, he said, would “own” it. Now Trump is trying to cripple the law while claiming ownership for himself and his party, with no idea what to do to fix it, and having even less ability to do anything than before.