“I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare, 100 percent own it,” said President (and part-time political pundit) Donald Trump, minutes after surrendering the fight for his American Health Care Act bill.
This is not correct. If any one person “owns” the seven-year-old law, that person is now Health and Human Services Secretary Tom Price. Literally.
Price, the orthopedic surgeon and former member of the House Tea Party Caucus, may have become the saddest man in Washington on Friday afternoon. According to the New York Times, he had “been studying how to [repeal the Affordable Care Act] for more than six years” when he was tapped by Trump to lead that effort. But instead of being the point person for repeal, now he will be responsible for the daily management of the law that he despises.
The Affordable Care Act was written to give the HHS secretary considerable latitude in implementation. But with that power comes a great political and moral dilemma for Price: improve the program, or undermine it?
Trump claimed on Twitter Saturday, “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!” But the president should worry about getting blamed for any explosion, especially if the cause can be traced to Secretary Price’s actions.
What might Price do? He could weaken enforcement of the individual mandate to purchase insurance, and slash marketing efforts. That would lead to fewer young and healthy people signing up for coverage, leaving behind a costlier pool of customers for insurers to cover.
Price can’t eliminate any of the 10 “essential health benefits” that insurance companies must cover under Obamacare – such as prescription drugs, mental health services, and physical therapy. But he could permit insurers to offer skimpier benefits for that coverage. That would allow for cheaper options, but would raise costs on consumers who use benefits previously considered essential.
Particularly challenging for Price is the question of subsidies for insurers, designed to help low-income consumers. The Republican-led House sued the Obama administration, claiming the law did not authorize the payments, and won an early round at the trial court level. But the ruling has been stayed pending appeal. If HHS abandons the case and stops the payments, Kaiser Family Foundation’s Larry Levitt says, “you could see insurers running for the exits.”
Another questionable gambit already in the works, which would effectively scale back Obamacare’s expansion of Medicaid, encourages states to impose work requirements on Medicaid recipients.
The proposal tracks conservative orthodoxy on demanding work in return for welfare. But often the unemployed need medical help so they can get healthy enough to rejoin the workforce. And some of those who would lose coverage when they need it most will be Trump voters. As CNBC reported, “in some key states that backed Trump, whites comprise a large majority of nonelderly Medicaid beneficiaries: 65 percent in Ohio, 60 percent in Wisconsin, 60 percent in Michigan. Those proportions are as high or higher in smaller Trump states such as West Virginia (89 percent), Montana (83 percent), Kentucky (77 percent) and Arkansas (62 percent).”
Could Price do some or all of these maneuvers, and still leave Trump enough running room to blame Democrats for the negative repercussions? No doubt Republicans would claim that the meltdown was inevitable. But the Congressional Budget Office just concluded, despite the warnings of Trump and most Republicans, that the marketplaces “would probably be stable in most areas” under the Affordable Care Act.
However, if Price cuts off insurer subsidies and actively discourages enrollment, all bets are off, and Democrats would have the grounds to charge them with mismanagement. Furthermore, there would be no way to shift blame for directly taking away certain benefits or complete coverage. Trump potentially faces a lose-lose scenario: either mocked for being wrong or scorched for deliberate sabotage.
There is one way to ensure Democrats fully own Obamacare: have Price resign and replace him with a Democrat. Price would probably love to be off the hook from administering a program he dreamed of vaporizing. And for Trump: this could be a win-win scenario. If Obamacare does explode under Democratic management, he was completely right. If Obamacare hums along, he’s a political genius for crossing the aisle to pick the right person for the job.
Of course, that’s not going to happen. But there’s one other crazy trick that just might work: simply manage the Affordable Care Act in good faith.
If, instead of continually predicting doom, Trump instructed Price to enroll more customers and follow through on aid for insurers, voters may just be happy with the results come Election Day. It’s called governing. Try it!