Donald Trump Threatens to Sabotage Obamacare


By THE EDITORIAL BOARD
APRIL 19, 2017


After Republican leaders in Congress failed to destroy the Affordable Care Act last month, President Trump tweeted that the law would “explode.” Now he seems determined to deliver on that prediction through presidential sabotage.

Mr. Trump is threatening to kill a program in the A.C.A. that pays health insurers to offer plans with lower deductibles and out-of-pocket expenses to about seven million lower-income and middle-class people. The president thinks that this will get Democrats to negotiate changes to the 2010 health law. This is cruel and incredibly shortsighted. Without these subsidies, health care would be unaffordable for many Americans, including people who voted for Mr. Trump because they were frustrated by high medical costs.

These subsidies lower the cost of medical care for people who earn between 100 percent and 250 percent of the federal poverty level. For a family of four, that income is $24,600 to $61,500 a year. For example, the deductible on qualifying Obamacare policies for families living at the poverty line in Charlotte, N.C., would be $1,000, compared with $10,000 for a standard policy, according to government data. In Philadelphia a similar family would have no deductible, compared with a $5,000 deductible for policies without subsidies. The government is expected to spend $7 billion on subsidies in 2017, and nearly 60 percent of the 12.2 million people who bought Obamacare policies for 2017 benefit from them.

Conservatives have been trying for years to end these subsidies in an effort to destabilize the A.C.A. House Republicans filed a lawsuit in 2014 to prevent the Obama administration from making these payments to insurers without appropriations from Congress. A Federal District Court ruled in the Republicans’ favor, but President Barack Obama appealed the case and the payments have continued — so far, at least. Mr. Trump has to decide how to proceed.

It is not surprising that Mr. Trump would see the subsidies as a bargaining chip. Governing, to him, is a matter of quick-hit deals, and he shows no concern about gambling with the health of millions of people.

Even if Mr. Trump does not end the subsidies, experts say, many insurers are already skittish about the administration’s animosity toward the A.C.A. They could stop selling Obamacare policies if the payments went away. Some counties in red states like Arizona, Oklahoma and Tennessee could be left with no insurers for individuals and families that do not get coverage through employers. Companies that remain would increase premiums by an average of 19 percent to make up for the loss of government money, according to the Kaiser Family Foundation.

Many insurance companies and health experts are also worried that the government will stop enforcing the A.C.A. provision that requires people to buy coverage or pay a penalty. That would encourage healthy people to forgo insurance, leaving companies to cover a smaller, sicker population. The administration has suggested that it might look the other way if individuals don’t buy insurance.


There would be a huge political cost for disrupting the health insurance market. A recent Kaiser poll found that 61 percent of Americans say that Mr. Trump and Republicans in Congress would be responsible for any future problems with the A.C.A. Lawmakers need look no further than recent town hall meetings where voters lashed out at Republicans for trying to take health care away from 24 million people. Referring to the subsidies, Mr. Trump recently told The Wall Street Journal: “Obamacare is dead next month if it doesn’t get that money. I haven’t made my viewpoint clear yet. I don’t want people to get hurt.”

This isn’t Mr. Trump’s promised “insurance for everybody.” It sounds more like a two-bit Hollywood villain promising carnage if he doesn’t get his way.

Last edited by Goose (4/20/2017 5:21 am)