There are two considerations that suggest Trump is not going to “let Obamacare explode.”
For one thing, despite Republican hyperbole and hysteria, the Affordable Care Act is not “exploding” or going into a “death spiral” anytime soon. The Congressional Budget Office score on the failed GOP plan emphatically stated, “Decisions about offering and purchasing health insurance depend on the stability of the health insurance market—that is, on having insurers participating in most areas of the country and on the likelihood of premiums’ not rising in an unsustainable spiral. The market for insurance purchased individually (that is, nongroup coverage) would be unstable, for example, if the people who wanted to buy coverage at any offered price would have average health care expenditures so high that offering the insurance would be unprofitable.” However, the CBO found that “the nongroup market would probably be stable in most areas under either current law or the legislation.” That supposes that the administration does not take active measures to sabotage the current system.
Second, presidents don’t have the option to allow great national tragedies unfold, refusing to act because it is not their fault or because they predicted tragedy. That’s how a narcissist might think — I will show them! — or someone entirely lacking in empathy. In the real world, the pressure from Congress, the media and affected voters would be intense for the administration to take some action if, for example, remaining insurers pulled out or an even higher percentage of young people refused to join the exchanges. Every president takes office both as the beneficiary and the unlikely recipient of his predecessors’ record. Trump could no more allow health care to “explode” than he could allow Iran to go nuclear because the Joint Comprehensive Plan of Action was flawed.
Now this also raises the possibility, as Democrats have fretted, that Trump intentionally will try to wreck the health-care system — not just “let it explode.” That indeed is precisely what Democrats accused the administration of doing when, for example, it suspended advertising to encourage people to sign up for the exchanges, or when Sen. Marco Rubio (R-Fla.) advanced legislation blocking the risk corridors, which were intended to cushion the blow for insurance companies losing money on the exchanges.
“For the president to say that he’ll destroy it, or undermine it, that’s not presidential. That’s petulance,” declared Senate Minority Leader Chuck Schumer (D-N.Y.) on Sunday on ABC’s “This Week.” “Being petulant, not a president. It’s not going to work. The job of the president is to make Americans’ lives better. And if he, out of anger or vengeance or whatever, starts undermining ACA, it’s going backfire on him because he’s the president and the American people know he’s in charge and they want him to make things better.” History suggests that Schumer is right. FDR had to act to fix the Great Depression; Ronald Reagan had to act to renew U.S. military strength. Presidents who are indifferent to American suffering and/or derelict in their duties do not remain in office.
Moreover, that will shift the onus back onto Republicans, who, as we have seen over the past three weeks, have only the faintest idea how to create a system better than Obamacare for those who previously could not find affordable coverage. Contrary to the assertions of the Freedom Caucus and libertarians such as Sen. Rand Paul (R-Ky.), the American people do now consider health-care coverage to be a right, as it is in all other developed countries, and therefore see a role for government in ensuring that people have access to coverage. Repealing Obamacare with no substitute for the current subsidies in the exchanges and without expanded Medicaid has no discernible constituency apart from hard-right ideologues. That surely wasn’t what Trump’s alienated, white, older, working-class voters (especially in rural areas) voted for.
Trump and the Republicans, after painting such a dire portrait of health care and anticipating Obamacare’s imminent demise, are cynically cavalier in moving on to other things after a mere 17 days of attention to this supposedly dire situation. They cannot have it both ways: Either the health-care situation is urgent (requiring them to keep at their work) or their hysteria was contrived, in which case they can choose to move on to other things, leaving voters to ponder why they should trust Republicans on other issues. Maybe the lesson here is that voters shouldn’t — neither the Republicans’ diagnosis nor proposed solution for health care suggests they care enough to govern seriously and well.