With the Affordable Care Act the battlefield for weekly political combat in Washington, it’s worth asking, how did this happen?
Congress passed the ACA in 2010 and it went into effect in 2014. Most laws become a routine part of society. Yet President Donald Trump is now hacking away at Obamacare, as the ACA is known, with every tool he can rummage. It’s rare for the federal government to undo itself so abruptly.
The ACA is unusually vulnerable because Congress passed it with the near-total support of one party, the Democrats, and nearly universal opposition from the other party, the Republicans. Opposition to the ACA among the American public has softened over time, with favorable views now exceeding unfavorable views by 46% to 44%, according to Kaiser. In the political arena, however, views remain hardened and bitter, fueling Trump’s crusade to dismantle the ACA.
Obamacare’s worst moment, in terms of popular appeal, came near the end of 2013, when the law’s impact began to affect real people. As we all know now, President Barack Obama sold the law by claiming that “if you like the plan you have, you can keep it.” As insurers began to comply with the law, they began to prove Obama wrong, canceling plans that didn’t meet the law’s requirement and forcing some consumers into plans that covered more, but also cost a lot more. Obama misled the public. He said everybody would end up better off under his plan, but some people ended up considerably worse off.
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Will Trump also pay a political price for his actions?
Trump is now doing essentially the same thing. Health care is still an intensely partisan matter in Washington, with recent efforts to repeal the ACA in Congress receiving only Republican votes. There were a few GOP defections that sunk those bills, however, which is why Trump is now trying to repeal the ACA piecemeal through executive actions.
Trump has signed off on an executive order that would loosen rules on insurers, allowing them to offer “skimpy” plans that would cover less but also cost less. Those might appeal to healthy people who don’t want to pay for a wide range of benefits they might never need, but as they leave the ACA insurance pools, more sick people will be left behind, pushing premiums for that group higher and higher. Trump also says he’ll cancel subsidy payments to insurers meant to reduce some out-of-pocket costs for low-income customers. That could push premiums higher still for people who get ACA plans.
Obama’s Democrats paid a steep political price for passing the ACA in partisan fashion, when they lost both houses of Congress in 2010. They’ve been out of power in Congress ever since. Trump could be setting his party up for the same sort of comedown, especially given that his executive actions are generally unpopular. Seventy-one percent of voters say Trump should fix the ACA instead of wrecking it. That includes 93% of Democrats and 74% of Independents. Even among Republicans, 48% say fix it while just 43% say kill it. Trump is basically saying he’ll do what he wants because he knows best, and hopes to bring the public along. Sound familiar?
Trump is going further by pursuing actions that seem certain to hurt some while helping others. That’s another Obama mistake, one that helped him lose control of Congress. Trump’s actions seem likely to result in fewer people having access to health insurance, which in turn will hurt sick or injured people who lose coverage just as they need it most. There are sure to be prominent stories of Trumpcare victims, just as there were prominent stories of Obamacare victims in 2013. If Trump thinks he’s impervious to the kinds of political pressures that left Obama politically stranded in Washington, he probably ought to spend a little more time in the swamp.
Trump promised voters he’d replace Obamacare with “something terrific.” He said “no one will lose coverage” and “everyone’s going to be taken care of.” That is not what Trump is actually doing, however, and it’s not hard to imagine health care searing Trump politically just as it seared Obama.