Trump’s “let Obamacare implode” is a cruel, nihilistic policy that does nothing to solve the real problems in health care.
PRESIDENT Donald Trump’s “let Obamacare implode” strategy should come with a flashing red warning: If you break it, you own it.
Of course, it is not a political strategy. It’s a talking point aimed at the hardest base of the GOP. As a policy, it is a prescription for escalating health-care costs and devastation to already fragile rural economies as a legion of newly uninsured people, many of them in Trump-voting counties, demand care from hospitals that cannot afford a spike in charity care.
The U.S. Senate’s failure to repeal Obamacare last week does not end the debate about the Affordable Care Act. Nor should it. The ACA has obvious flaws acknowledged by its own supporters. Fixing them, with a bipartisan and deliberative approach, would be a priority if the Republican caucus had more sensible minds like Sens. Susan Collins of Maine and Lisa Murkowski of Alaska. They joined Sen. John McCain to rebuke the repeal strategy.
A glimmer of hope comes from U.S. Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, who said he will work with Washington’s Sen. Patty Murray on a bipartisan, if temporary, solution. The ranking member of the committee, Murray welcomed the overture, which includes hearings and a proposal to extend payments to insurers through 2018.
Trump, nonetheless, acts like a cruel nihilist in threatening the foundations of the Affordable Care Act. Through executive power, he could stop payment on the estimated $7 billion in cost-sharing subsidies for low- and moderate-income buyers of health insurance. That could effectively make health insurance unaffordable for up to 10 million people.
He has other levers, including monkeying around with the Medicaid expansion, which helped drop Washington state’s uninsured rate to 7 percent, with the steepest drops in counties in this state that Trump won. He should stop threatening to harm his base, and his base should demand rational governance.
In the absence of constructive action from the White House, Washington state’s health-care leadership must buckle down for a bumpy ride. Insurance Commissioner Mike Kreidler said he is most concerned that rural counties will be left with no insurer for individual plans, a scenario barely avoided this year. Several counties have only one provider.
Kreidler is working on several contingency options, including expanded use of a high-risk insurance pool that could step in for unusually high-cost illnesses and for individuals. He is also exploring opening a public option if counties were left with no private insurer, using the insurance pool for state employees.
This intriguing idea deserves a full vetting, because Kreidler sees the current trajectory on health insurance on the individual market ending with a crash. Washington has seen that before, nearly two decades ago, and it was chaos.
Trump’s disinterest in solving the big problems of health care — including cost and access — is remarkable because it is so callous. Instead of merely working to score political points off the Obama legacy, Trump and the GOP-led Congress need to work with Democrats and fix, not toss, the Affordable Care Act.