President Donald Trump revealed his plans for the Affordable Care Act on Thursday, announcing that the government would no longer be paying out the law’s required subsidies for insurers.
According to the non-partisan Congressional Budget Office, this decision will cause premiums in Obamacare plans to be 20 percent higher than they would have been by 2018, and 25 percent higher by 2020. Trump’s plan will also increase the deficit by $6 billion in 2018, $21 billion in 2020, and $26 billion in 2026. Getting rid of these cost sharing reduction payments will negatively impact millions of people: According to the non-partisan Kaiser Foundation, 7 million people qualified for support from these CSR payments this year.
What is the political calculus of making a decision that will cause millions of Americans to see their premiums rise and potentially destabilize insurance markets?
President Trump tweeted this on Friday:
ObamaCare is a broken mess. Piece by piece we will now begin the process of giving America the great HealthCare it deserves!— Donald J. Trump (@realDonaldTrump) October 13, 2017
The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!— Donald J. Trump (@realDonaldTrump) October 13, 2017
Trump is basically confessing to lighting the fuse to blow up Obamacare, pointing at the dynamite, and saying “look at that smoldering mess Democrats made.” This is consistent with his past rhetoric on the topic. "I think we're probably in that position where we'll let Obamacare fail. We're not going to own it. I'm not going to own it," Trump said in July.
So… will this work? It’s certainly possible that Trump’s message will resonate with his base. His ability to create an alternate universe and vilify innocents should never be underestimated. But there’s been some polling on this question of whether or not voters will ultimately consider Republicans and President Trump responsible for a system they control and are now intentionally sabotaging. And it’s not great for Trump.
A Hart Research poll of 2016 voters last month showed that 61 percent of respondents already felt that Trump was trying to make Obamacare fail, 78 percent of voters wanted Trump and Republicans to take the necessary steps to stabilize markets, and that 71 percent of voters would consider Trump at least partially responsible and 83 percent of voters would consider Congressional Republicans at least partially responsible if premiums rise next year and there are fewer insurers on the individual market.
That same poll found that Democrats might even be able to run on such an issue. Democrats were beating Republicans on the generic Congressional ballot 43 to 36, but that margin increased to 56 to 44 when voters were presented the option of Democrats who would fix Obamacare and Republicans who would dismantle it.
The numbers track with a Kaiser poll released in August that said 78 percent of Americans felt Trump should try to make the current law work and only 17 percent supported actively undermining it.
On the key point of who “owns” health care, 60 percent of respondents in the Kaiser poll said it was Trump and Republicans and 28 percent said it was Obama and Democrats.
Though Republican leadership will attempt to spin this decision as one for freedom and liberty, a handful of Republicans have acknowledged that ending these subsidy payments is bad news. Earlier this year, Republican Senate leaders essentially begged Trump to continue issuing the cost saving reduction payments. Chairman of the Senate Republican Conference, Sen. John Thune, literally said in August: "I hope the president will continue to make those payments.” Chairman of the Senate health committee, Sen. Lamar Alexander, said this earlier this year: “Without payment of those cost-sharing reductions, Americans will be hurt.” And last night, Republican Rep. Ileana Ros-Lehtinen tweeted: "Cutting health care subsidies will mean more uninsured in my district.”
Seems pretty straightforward.
Speaking to CNN on Friday, retiring Republican Rep. Charlie Dent of Pennsylvania may have said it best:
I am fearful now that the president has made this announcement, this will destabilize insurance markets, it will raise premiums for a lot of folks. … Premiums will spike, there will be greater instability in the insurance market and there will be likely larger number of people that become uninsured.
What about the question of who would own such a system?
“I think the president is ill advised to take this course of action because we at the end of the day will own this,” Dent said. “We the Republican party will own this.”
But what about Barack Obama? His name is right there in the law?
Barack Obama is a former president. President Trump is the president. He is Republican. We control the Congress. So we own the system now.
Barack Obama is no longer in the equation. So this is on us.
This is fairly easy to understand. If voters continue to agree, the damage Trump does to his own political party could be as great as the damage he is now doing to the American health care system.