President Trump’s administration was not shy about its health-care scheme: If it couldn’t repeal the Affordable Care Act outright, it would sabotage it, meaning the White House would create uncertainty and move to end the cost-sharing reduction payments that helped keep premium costs down and keep insurers in the market. Republicans repealed the individual mandate, and the administration cut down on ACA advertising intended to remind the public about open enrollment. Trump’s theory, which he never hid, was that the public would blame President Barack Obama and Democrats would have to agree to one of the GOP plans they unsuccessfully tried to implement in 2017. Let Obamacare “implode,” he declared. As child separation was to immigration (the intentional infliction of pain on innocents to get his way), Trump’s approach of strangling Obamacare (make it more expensive, the exchanges more unstable for consumers) was to health care.

Trump was “successful” in making Obamacare worse — and now Republicans are nervous they might actually be held accountable for the pain inflicted on people who need health-care coverage. Politico reports:

Obamacare premiums are once again poised to spike by double digits in 2019, causing heartburn for politicians as voters will head to the polls within days of learning about the looming hit to their pocketbooks.
But unlike recent campaign cycles, when Republicans capitalized on Obamacare sticker shock to help propel them to control of Congress and the White House, they’re now likely to be the ones feeling the wrath of voters.

In some places the exchanges are working fine (no death spiral as Republicans predicted), but “double-digit premium increases are still likely in many states, as evidenced by the rate filings that have been trickling out in recent weeks. … While rates won’t be finalized until the fall, it’s already clear that there will be wide discrepancies across the country that could affect the political salience of the issue.”

Coupled with the administration’s refusal to defend Obamacare in court — and hence not defend the protection for those with preexisting conditions, which affect at least 50 million Americans — Trump’s anti-ACA moves are like a flashing neon sign: “Republicans want to take away your health-care coverage!”

Sentient Republicans have figured out this means they are going to get blamed. Axios reports, “A source close to Republican leadership emails about the biggest political clouds hovering over the rest of the year: ‘Only thing that matters now is a) how bad they get crushed on ACA premium increases; b) the final Mueller verdict; and c) how crazy Trump gets with the [continuing resolution].'” Democrats agree the ACA is now a GOP problem. (“Senior Democratic sources say their polling shows voters are now blaming their dissatisfaction with health care on the party that controls the House, Senate and White House rather than the party that implemented the Affordable Care Act,” Axios reports.)

“They should be worried,” Topher Spiro of Center for American Progress tells me. He adds, “There is no escaping blame: The Congressional Budget Office, [former health and human services secretary] Tom Price, insurers and insurance commissioners have all cited GOP policies as a major factor driving premium increases.” He continues, “The thing is, this was all known in advance.”

Republicans whining about getting blamed for ACA problems is akin to the kid who murders his parents and then throws himself on the mercy of the court as an orphan. “From the beginning of the term, Trump and congressional Republicans have taken actions which raised premiums by double digits on ordinary American families,” Andy Slavitt, the former chief of the Centers for Medicare and Medicaid Services, tells me. “Now that Americans are feeling it, Republican candidates will attempt to distance themselves in the midterms. This seems particularly challenging as Trump proudly claims of the ACA that ‘We gutted it.’ ”

To make matters worse, polling shows that Obamacare, as has been the case since Trump went after it, remains popular and important to voters. The Kaiser Family Foundation’s poll released in May, for example, showed that Obamacare is more important than almost any other policy issue for voters, and the most recent NBC News-Wall Street Journal poll found it was the most important midterm issue for voters. In the recent CBS News Battleground Tracker poll, 75 percent, the most for any issue, said candidates would need to match their views on health care to get their vote. A recent Quinnipiac University poll found voters by a 51 to 44 margin want to keep Obamacare in place. And the most recent CNN poll shows 54 percent of voters disapprove of Trump’s handling of health care, while only 33 percent approve.

If Republicans lose their shirts in November, it will be at least in part because more Americans lost, or are paying more for, health insurance. That is precisely how democracy works — representatives are held accountable for their actions. Maybe sabotaging Obamacare wasn’t the smartest political move, after all.