In late August, Iowa applied to the Department of Health and Human Services for a sweeping waiver to opt out of Obamacare’s structure and implement its own health coverage model. What Iowa was proposing, as my colleague Jordan Weissmann wrote over the summer, was a significant conservative rewrite of how it would allot its Obamacare dollars. In a number of ways, the Iowa plan mimicked the House-passed American Health Care Act. Other states having problems with their individual markets have been watching closely to see whether the Trump administration will approve something so broad.
The application for Iowa’s waiver is still pending. But, as the Washington Post reported Thursday night, one key figure in the administration has personally intervened to try to kill it: Donald Trump.
Trump, the Post reports, read a Wall Street Journal story about Iowa’s application in late August and got all het up about it. He first tried to call (now ex-) HHS Secretary Tom Price, who couldn’t be reached, but then got in touch with Seema Verma, the head of the Centers for Medicare and Medicaid Services. “Trump’s message in late August was clear,” the Post writes, “according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.”
There are a couple of possible explanations for why Trump did this. One would be that he objected to Iowa’s proposal on policy grounds. We’d rate this possibility as unlikely, since Trump does not know or care about the specifics of health policy in any way, shape, or form. That he had to read in the newspaper about the major health policy decision his government was facing tells you enough. Observing Donald Trump for five seconds tells you enough, too.
It is far more likely that Trump did this because, if the waiver does go through, it might make Iowa Republicans more content with life under Obamacare, with those revisions. This revelation shows in the most personal terms possible that Trump is willing to squeeze Obamacare from whichever direction he can until he gets his legislative “win” that kills it.
His administration has already been working to sabotage the upcoming open enrollment period by shortening it, cutting funding for outreach and advertising, and, most farcically, scheduling maintenance to the HHS website on weekend hours during the period. Trump maintained his public will-he-or-won’t-he posture on paying out cost-sharing reductions past the September deadline for insurers to finalize their 2018 rates, and told bipartisan negotiators in the Senate that he wasn’t interested in signing short-term stabilization legislation before that deadline, either.
Now we know, too, that he doesn’t want to allow a more conservative state to pursue changes that could lessen its zeal for repealing the Affordable Care Act.
This waiver may still go through, as a lot of people at HHS seem to want it to. (How else do you suppose this story saw the light of day?) But that will require bypassing a president who does not want anyone else finding satisfaction with the statutory status quo. Until Trump gets his win, he will try to make life under Obamacare as uncomfortable for as many people as possible. If Obamacare is working for you, he will try to sabotage that success. If Obamacare isn’t working for you, he will try to ensure that it continues not working. Whatever it takes to keep the repeal coalition together. It is a game to him, and he is incapable of understanding that it shouldn't be.