Donald Trump and his party have never been able to figure out a viable alternative to Obamacare. Having failed to repeal and replace the law, they have set out to wreck it. The Trump administration is taking two steps to accomplish this goal. First, it is opening two loopholes to allow healthy people to purchase unregulated insurance, splitting the market and loading more costs onto people with expensive medical needs. Second, it announced tonight it is ending cost-sharing payments to insurers who take on low-income customers.
Both these changes are designed to put pressure on insurers, increasing premiums by an average of 19 percent, and even splitting up the individual insurance markets. Whether they will succeed is yet to be seen. States committed to making Obamacare work will find solutions that keep their markets intact. (Indeed, there has been a marked difference in the premium levels of states that are trying to help cover their citizens and those that aren’t.)
What’s more, by withholding payments promised in the law, the administration is exposing itself to a lawsuit it could very well lose. (New York Attorney General Eric Schneiderman, California Attorney General Xavier Becerra, and others have already announced their intention to sue.) Premiums are going to rise in the meantime, because insurers are subjected to greater uncertainty and the now-demonstrated knowledge that the administration is deliberately sabotaging the law they are operating under.
The exchanges in 2017 had stabilized financially, as insurers found a profitable price point. The Republican Party has, as a matter of theological principle, refused to accept the possibility that Obamacare might succeed at its stated ends. If Obamacare were truly collapsing, sabotage would not be necessary. It is the law’s success, not its failure, that has made Trump so determined to wreck it. The White House has released a statement confirming its intention to end the payments, written in the pidgin English indicating the president’s own authorial hand:
Congress is not going to repeal and replace Obamacare. Trump is using crude threats to lure Democrats to accept his repeal plan:
The trouble is that every plan Trump has supported would throw even more people off their insurance than his sabotage would. There is no political or policy incentive for them to give him political cover for policies to deny Americans health insurance. Their incentive is to highlight the sabotage that he is boasting about, and fight.
The Medicaid expansion, which accounts for a majority of the law’s coverage gains, remains in place and is not vulnerable to administrative sabotage. Individual consumers are going to experience a lot of financial pain as a result of Trump’s action. As premiums rise in response to the sabotage, the main public recourse will be to replace the Republican-led government with one capable of passing a workable and humane health-care law.