The Trump administration’s surprise decision to back a lawsuit seeking to overturn the Affordable Care Act in its entirety has clearly freaked out the president’s Republican advisers and allies. As Axios reports, dissenters include the two most relevant Cabinet secretaries (Health and Human Services Secretary Alex Azar and Attorney General Bill Barr), House Republican Leader Kevin McCarthy, and an assortment of GOP senators. They’re all gobsmacked about Trump’s willingness to take their party back down the rabbit hole of Obamacare at a time when the law is more popular than ever, and mystified by the timing:
McCarthy told Trump over the phone that the decision made no sense — especially after Democrats killed Republicans in the midterms in part over the issue of pre-existing conditions, according to two sources familiar with their recent conversation. As Bloomberg’s Sahil Kapur points out — health care was the top issue for 2018 midterm voters, and voters who cared most about health care favored Democrats over Republicans by more than 50 percentage points.
While some insiders are blaming White House chief of staff Mick Mulvaney and a few others of engineering this politically obtuse move, it’s pretty clear Trump himself has bought into it:
Several Republican senators told Axios they were surprised Trump spent most of the Senate GOP lunch on Tuesday on health care. Trump led with health care and went back to it several times during the meeting. “He’s clearly very passionate about it,” Sen. John Kennedy said. “It was one of few times at these things the president spoke more than the senators.”
Aside from the folly of bringing up Obamacare again at a time when Republicans have spent months changing the subject to alleged Democratic extremism in the form of Medicare for All, there’s the nagging question of what, exactly, Republicans would do if the dog caught the bus and Obamacare disappeared. Now Trump has chosen to reassure the nation on that front:
So what does Trump have in mind? A reasonably good guess would be the Obamacare replacement plan that’s in his recently released fiscal year 2020 budget as described by health-care policy wizard Sarah Kliff:
Repealing Obamacare and replacing it with Graham-Cassidy. Those who followed the Obamacare repeal debate closely will certainly remember the replacement proposal from Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA). As I’ve written previously, this plan would allow insurers to discriminate against those with preexisting conditions and significantly cut insurance subsidies for low- and middle-income Americans.
In case you’ve forgotten, Graham-Cassidy was the last-gasp, final Obamacare “replacement” proposal congressional Republicans considered in 2017 before throwing in the towel and moving on to their tax cut legislation. As Kliff notes, it would have liberated insurers to discriminate against those with preexisting conditions — the very issue on which Democrats successfully bludgeoned Republicans during the 2018 midterms — and would have taken a fateful step toward shifting costs for low-income health-care coverage to the states via a combination of Obamacare block grants and Medicaid per capita spending caps. An analysis in the New England Journal of Medicine labeled Graham-Cassidy “the most harmful ACA repeal bill yet.” And the Center on Budget and Policy Priorities described the impact on health insurance as dire:
Because CBO was asked to analyze Cassidy-Graham so rapidly, it was unable to estimate the magnitude of its effects on coverage but concluded the bill would cause “millions” to become uninsured. Drawing on CBO analyses of earlier bills, independent analysts at the Brookings Institution estimated last year that a version of Cassidy-Graham would cause about 21 million people to lose coverage in the years when its block grant was in full effect.
If that’s what Trump has in mind, it’s not likely to strike many people as “far better than Obamacare.” And it will not, of course, be enacted; even if Republicans can finally get over the hump with an Obamacare replacement plan in the Senate, the Democratic-controlled House won’t enact it.
And for that matter, it’s unlikely the U.S. Supreme Court, even with its conservative majority, is going to embrace the much-derided theory by which Texas district court judge Reed O’Connor struck down the Affordable Care Act.
So if this whole thing is largely hypothetical, why oh why is Donald Trump going so far out of his way to draw attention to it and express his joy over a bad legal decision and an even worse proposal to implement it, all at the worst possible time?
That’s hard to say. And for all anybody actually knows, Trump’s plan for an Obamacare replacement is: We’ll figure that out mañana. But it will be great.