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Opinion Trump’s new sabotage of Obamacare actually points a gun at the heads of Republicans

President Trump's health-care actions could have ripple effects throughout the Affordable Care Act's marketplaces. (Video: Jenny Starrs/The Washington Post, Photo: Jabin Botsford/The Washington Post)
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President Trump’s peculiar combination of malevolence, certainty in his own negotiating prowess and cluelessness about the details of policy sometimes leads him to issue fearsome-sounding threats that are rooted in a baffling misread of the distribution of leverage and incentives underlying the situation at hand.

Case in point: The big news of the morning, which is that Trump will cut off paying the “cost-sharing reductions” in his latest bid to sabotage the Affordable Care Act. Trump just tweeted that if Democrats don’t like this, they should negotiate with him to fix the law, in keeping with his previous suggestions that if he let the law fail, they would feel pressure to do this:

In reality, this move actually puts more pressure on congressional Republicans than on Democrats to agree to such a “fix.”

As luck would have it, there is already a bipartisan set of negotiations — led by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the leaders of the health and education committee — that have been continuing over how to shore up the Affordable Care Act’s individual markets. According to a Democratic source familiar with the talks, there is broad agreement that Congress should appropriate the money to cover the billions of dollars in cost-sharing reductions (CSRs), which, if halted, could cause the individual markets to melt down. The sticking points are over how much flexibility the deal should give to give states in defining what counts as insurance coverage, and there’s a decent chance those sticking points will be resolved.

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Indeed, Alexander has publicly confirmed that he believes Congress should appropriate the funds to cover the CSRs. He has also publicly allowed that he believes Murray has already made serious concessions towards the flexibility of ACA rules that Republicans want, though Murray still insists that the regulations requiring insurers to offer “essential health benefits” must remain. What this means is that, presuming a deal is reached, the real lingering question will be whether Republican leaders in Congress will accept such a compromise and allow a vote on it.

And the pressure on Republicans to do that will be intense. The Washington Examiner recently reported that vulnerable House Republicans worry they could have a major political problem on their hands if these payments are stopped, because it could harm large numbers of people in their districts. As it is, millions are enrolled in plans with cost-sharing reductions, which pay money to insurers to subsidize out-of-pocket costs, and if they are halted, insurers could exit the markets, further destabilizing them and leaving millions without coverage options. Tellingly, influential House Republicans such as Reps. Tom Cole (Okla.) and Greg Walden (Ore.) have called for Congress to appropriate the payments.

To be clear, the issue here is not necessarily that Trump is wrong on the merits for halting the payments. They are the subject of an ongoing battle over whether they are legal, and even some legal types who are sympathetic to the ACA think they probably aren’t. But there is no chance this is what is motivating Trump. We know this, because he previously said he believed threatening to cut off the payments — and more broadly, that letting Obamcare “fail” — would give him leverage over Democrats. It doesn’t, but this still confirms what is really driving Trump.

Regardless, right now, the issue is whether Congress will appropriate the payments to cover the CSRs. It would not be that hard to reach a bipartisan deal to do this, at which point the question will become whether GOP leaders and Trump will support it. If not, it is likely that Trump and Republicans will take the blame for any disruptions that ensue.

By the way, when Trump says Obamacare is “imploding,” which will allegedly pressure Dems, he’s lying: The exchanges were stabilizing, and many of their travails are largely attributable to his own multiple efforts to sabotage them. The public understands this: Large majorities say Trump and Republicans will own the ACA’s problems going forward and want them to make the law work.

So in what sense will Democrats feel pressure from Trump’s escalating sabotage? All the versions of repeal Trump has supported would harm more people than stopping the CSRs will. Why would Dems feel pressure to choose the former over the latter? It’s true that Dems, worried about the humanitarian toll this could have, might be more inclined to make concessions in the talks with Alexander. But all indications are that Alexander is approaching those talks in good faith and that a reasonable deal is possible.

In the end, Trump and Republicans are the ones likely to feel more pressure to support such a deal, which will put them in the tough spot of choosing between taking the blame for chaos in the individual markets and weathering the rage from the right that accepting a deal will unleash. Even if Trump doesn’t understand this, congressional Republicans surely do.

* TRUMP WON’T KILL IRAN DEAL, BUT HE’LL WOUND IT: The New York Times reports that Trump will give a speech today announcing he’ll decertify the Iran deal, which punts the hard decision over to Congress:

Doing so essentially kicks to Congress a decision about whether to reimpose sanctions on Iran, which would blow up the agreement. But the Trump administration made it clear that it wants to leave the 2015 accord intact, at least for now. Instead, it is asking Congress to establish “trigger points,” which could prompt the United States to reimpose sanctions on Iran if it crosses thresholds set by Congress.

Republicans have suggested they won’t reimpose the sanctions, and “trigger points” could allow them and Trump to argue they are being super tough in enforcing the deal, unlike weak Obama.

* TRUMP MAY EXTEND DEADLINE FOR ‘DREAMERS’: The Post reports that Sen. James Lankford of Oklahoma (R) says Trump told him he might extend the cutoff for the dreamers past March 5 if a legislative solution is not worked out by then:

“The president’s comment to me was that, ‘We put a six-month deadline out there. Let’s work it out. If we can’t get it worked out in six months, we’ll give it some more time, but we’ve got to get this worked out legislatively,’'” Lankford said outside a town hall here Thursday night. … “His focus was, ‘We’ve got to get a legislative solution.'”

That’s nice, but given Trump’s volatility, these hundreds of thousands of people can’t count on that happening, meaning they will still fear the likelihood of major disruptions to their lives.

* PUERTO RICO RAGES AT TRUMP’S CALLOUSNESS: Trump threatened yesterday to withdraw aid workers from Puerto Rico’s horrifying humanitarian disaster, and the Post sums up the reaction there:

Residents and elected officials responded … with outrage and disbelief. Radio disc jockeys gasped as they read aloud the presidential statements, while political leaders charged that he lacked empathy and pleaded for help from fellow U.S. citizens on the mainland. Trump has been roundly criticized for his seeming reluctance to come to Puerto Rico’s aid. During last week’s visit to San Juan, the president tossed rolls of paper towels at residents as if shooting baskets.

Which pundit will be the first to claim that “Trump’s base will love this”?

* SETTING RECORD STRAIGHT ON PUERTO RICO: Paul Krugman acknowledges that Puerto Rico did face financial hardship before the hurricane, some rooted in mismanagement, and comments:

But much of it reflected changes in the global economy — for example, growing competition from Latin American nations — reinforced by policies imposed by Washington, like the end of a crucial tax break and the enforcement of the Jones Act, which forces it to rely on expensive U.S. shipping. … all of this should be irrelevant. … How can we be abandoning them in their time of need? Much of the answer, no doubt, is the usual four-letter word: race.

Meanwhile, Eugene Robinson suggests that abandoning Puerto Rico might be an impeachable offense.

* SUSAN COLLINS WILL NOT RUN FOR GOVERNOR: Sen. Susan Collins (R-Maine) announced today that she will not run for governor, after all, saying she wants to continue playing a key role in Congress. As CNN reports, one thing that weighed on her thinking was “the reality of Collins’ prominent role in the Senate — where she has seniority and is a swing vote on nearly all major legislative items.”

This is in one sense a loss for Democrats — if she were to depart the Senate, that would be a blow to GOP chances of retaining their majority. But Collins can still exercise influence in the Senate that could help prevent Trump and Republicans from doing too much damage — after all, she basically tanked repeal.

* AND IT’S TIME FOR REPUBLICANS TO PANIC: Michael Gerson argues that Sen. Bob Corker’s (R-Tenn.) caustic criticism of Donald Trump has presented Republicans with a crossroads moment:

The time for whispered criticisms and quiet snickering is over. The time for panic and decision is upon us. … The American government now has a dangerous fragility at its very center. Its welfare is as thin as an eggshell — perhaps as thin as Donald Trump’s skin. Any elected Republican who shares Corker’s concerns has a political and moral duty to state them in public. If Corker is correct, many of his colleagues do have such fears. Their silence is deafening and damning.

Corker has confirmed that Republicans know Trump is unfit for the presidency, making it impossible for them to pretend otherwise any longer. It is now on the media to flush this out into the open.