I have a theory to explain it, one that can be seen in today’s big news that the Trump administration has issued a rule to dramatically cut back the Affordable Care Act’s contraception mandate and in the administration’s ongoing sabotage of the ACA in general.
The explanation comes down to this: Trump is willing to do things that are politically foolhardy in order to satisfy his base voters, no matter how limited a portion of the electorate they make up. This is certainly not rooted in any principles — instead it likely reflects either a failure to understand how things play with the broader electorate or that he believes a relentless focus on maintaining that base’s loyalty is the key to his political survival, or some combination of both.
First, here’s the contraception mandate news, from Juliet Eilperin, Amy Goldstein and William Wan:
The Trump administration issued a rule Friday that sharply limits the Affordable Care Act’s contraception coverage mandate, a move that could mean many American women would no longer have access to birth control free of charge.The new regulation, issued by the Health and Human Services Department, allows a much broader group of employers and insurers to exempt themselves from covering contraceptives such as birth control pills on religious or moral grounds. The decision, anticipated from the Trump administration for months, is the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 health-care law nearly from the start.Several religious groups, which battled the Obama administration for years over the controversial requirement, welcomed the action.
It’s true that certain far-right Christian groups have complained about the contraceptive mandate. But it’s also true that it is hugely popular among the public as a whole. A Kaiser Family Foundation poll in June found that Americans supported it by a margin of 68 percent to 29 percent. Even a majority of Republicans supported the mandate.
Now let’s move to our second story, about the individual health insurance markets regulated by the ACA. After Trump took office, there was a widespread assumption that now that Republicans had complete control of the government, their approach to the Affordable Care Act would have to change. Since they now control the entire government, the public will hold them responsible for any ongoing problems in health care, just as the president always gets blamed for bad economic times and credit for good times, whether he deserves it or not.
Polling strongly suggests that this is right — that majorities will hold Trump and Republicans responsible for any problems with the ACA and want them to make the law work.
But here’s where Trump’s unique perspective on politics comes into play: He either doesn’t understand the political risks of intentionally undermining the American health-care system, or he believes that only keeping his base happy is the key to his survival. So he is willing to undertake a truly spectacular campaign of sabotage. Here’s the latest story on that front, from Eilperin:
For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application.Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.
This is just one example, but it’s part of a whole range of actions the administration has taken that are, and I’m not exaggerating here, purposefully intended to drive as many healthy people as possible out of the individual insurance market, which will cause premiums to spike and potentially create a “death spiral” that would ultimately lead to the market’s collapse. As I recently summarized this campaign of sabotage:
They have threatened to withhold cost-sharing payments from insurers, which has already driven premiums up substantially. They cut the open enrollment period in half. They slashed the budget for advertising to encourage people to enroll by 90 percent, and used some of what was left to create videos meant to discourage people from getting insurance. They canceled contracts with community groups that assist people in the sometimes complicated process of signing up. And in a particularly creative move, they’ll be shutting down healthcare.gov on [every Sunday except one] during open enrollment, for “maintenance.”
And they’re doing all this after it has become clear they won’t be repealing the ACA any time soon. From a political standpoint it’s impossibly stupid, because it gives Democrats all kinds of ammunition to say that Trump and the Republicans are destroying your health care. A different Republican administration would grudgingly implement the ACA and look for conservative ways to allow states to improve their systems. The Trump administration, and Trump personally, seem to want to make things as awful as they can for as many Americans as they can.
If you’re a venomously anti-government Trump voter, this is great news. Forget all those lazy freeloaders who want to suckle on the government’s teat and think they have a right to some help in affording health care! Take that, Barack Obama! But if you care about whether the Republican Party is going to hold Congress and the White House, it’s a terrible idea.
These kinds of actions are guaranteed to provoke a backlash that will put the Republican majorities in Congress at greater risk, in an upcoming midterm election where things already look dangerous for them. But Trump doesn’t seem to care. So if you’re a certain kind of Trump voter, he’s coming through for you, bigly. At least for now.