WASHINGTON — In the weeks since President Trump’s attempts to replace the Affordable Care Act collapsed, the administration has debated what to do: Try again? Shore up the insurance marketplaces? Or let the whole system collapse?
Mr. Trump has failed to get enough support from his own party, but he hopes to get the Democrats’ help by forcing them to the negotiating table with hints about the chaos he could cause.
His bargaining chip is the government subsidies paid to insurance companies so they can reduce deductibles and other out-of-pocket costs for low-income consumers — seven million people this year.
In an interview with The Wall Street Journal this week, Mr. Trump threatened to withhold the subsidy payments as a way to induce the Democrats to bargain with him.
Explaining the Health Payments That Trump Is Threatening to End
Cost-sharing reductions seem like an arcane aspect of the Affordable Care Act, but they could now make or break the Obamacare insurance marketplaces. Even President Trump is talking about them, as a possible bargaining chip for a new health bill.
Mr. Trump this week repeatedly threatened to cut off the federal funding that makes the cost-sharing reductions work for insurers and patients. The idea, he told The Wall Street Journal, is that Democrats would be forced to negotiate with him over a replacement for the Affordable Care Act if they did not want the individual insurance market to collapse. The administration has been anything but clear about whether it wants that market to thrive or fail.
Can Trump Take Health Care Hostage?
“Obamacare is dead next month if it doesn’t get that money,” he declared, referring to cost-sharing subsidies that reduce out-of-pocket expenses for low-income families, and are crucial even to higher-income families, because they help keep insurance companies in the system. “I don’t want people to get hurt.” (Nice shop you’ve got here, shame if something were to happen to it.) “What I think should happen and will happen is the Democrats will start calling me and negotiating.” (I’m making them an offer they can’t refuse.)
It’s a nasty political tactic. It’s also remarkably stupid.
The nastiness should be obvious, but let’s spell it out. Mr. Trump is trying to bully Democrats by threatening to hurt millions of innocent bystanders — ordinary American families who have gained coverage thanks to health reform. True, Democrats care about these families — but Republicans at least pretend to care about them, too.
Why does Mr. Trump even imagine that this threat might work? Implicitly, he’s saying that hurting innocent people doesn’t bother him as much as it bothers his opponents. Actually, this is probably true — remember, we’re talking about a man who once cut off health benefits to his nephew’s seriously ill 18-month-old son to gain the upper hand in a family dispute. But it’s not the kind of thing one expects to hear from the occupant of the White House.
Donald Trump Threatens to Sabotage Obamacare
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.
