Cause Of Death: Neglect

As the Trump regime has broadly hinted at since last week's epic meltdown of the Trumpcare bill in the House, Greg Sargent notes that Trump could very well let existing Obamacare provisions collapse through simple refusal to enforce them.

Now that the GOP plan to wipe out Obamacare lies in smoking ruins, President Trump is mulling a new and fiendishly clever scheme: allow the law to collapse, or even further undermine it through executive action, and pin the blame for the resulting human toll on Democrats. As it happens, Trump does have the tools to inflict immense damage on the Affordable Care Act and hurt a lot of people in the process.

But once you subject this strategy to a moment’s scrutiny, it becomes obvious that it will not bring about the result Trump wants. Indeed, the thinking here reflects a resolute refusal to appreciate an important reason the repeal effort melted down in the first place.

Over the weekend, Trump tweeted: “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE.” This reaffirmed what he’d said on Friday, which is that the law will soon “cease to exist” — that Democrats will own the fallout and will be desperate to deal. As many quickly pointed out, this suggested Trump may go further than merely standing by as the law supposedly implodes, as he had previously contemplated doing, and may seek to actively harm the law. On “Fox News Sunday,” Reince Priebus declined to divulge the strategy.

If Trump wants, he can unleash serious damage by undermining the individual markets in three ways. Insurers currently making decisions will closely scrutinize signs from the administration to gauge those markets’ long-term viability. His administration can weaken the individual mandate through various mechanisms, which would mean fewer younger and healthier people and higher premiums. It can pull back on all forms of outreach designed to get people to enroll on the marketplaces. Or it can stop paying “cost-sharing reductions” to insurance companies, which enable them to reduce out-of-pocket costs for lower-income enrollees, which may encourage insurers to flee the markets. 

But Sargent says that won't work.

One of the hidden morals of the Great Republican Health Care Crackup of 2017 is that the American people flatly rejected replacing the ACA with something substantially more regressive. The GOP plan would have cut Medicaid spending by $800 billion, leaving 14 million fewer people with Medicaid coverage, while delivering an enormous tax cut to the rich. Americans clearly disapproved of this outcome. A recent Quinnipiac poll found that a majority opposed the GOP plan, but more to the point, 74 percent of voters, including 54 percent of Republicans, opposed cutting Medicaid. The public broadly opposed the GOP plan’s most prominent mechanism for rolling back spending to cover poor people.

The rejection of the GOP plan is an important historical marker in our interminable health-care debate. The American people were presented with the first genuine effort at a GOP consensus ideological alternative to Obamacare — one that would do away with the ACA’s effort to guarantee free or affordable coverage through government spending and regulations — and decided they preferred sticking with the latter. The Quinnipiac poll also found that 51 percent oppose repeal and 61 percent disapprove of Trump’s handling of the issue. As Jonathan Cohn puts it, the ACA “has shifted the expectations of what government should do ― and of what a decent society looks like.” There are zero indications that Trump and GOP leaders are capable of acknowledging this possibility.

Where we go from here is up to Trump and the GOP still, but we now know that they, not the Democrats, will own the outcome.