The Washington PostDemocracy Dies in Darkness

Trump now wants to gamble his presidency and his party on the strength of his salesmanship

Now President Trump is suggesting to repeal Obamacare, let the market fail and then come up "a great health care plan," which three senators quickly shot down. (Video: Jenny Starrs/The Washington Post, Photo: Andrew Harnik/The Washington Post)
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President Trump claims he wants to do with the Affordable Care Act what he’d done several times with his businesses: Let it fail and move on.

After a 12-hour stretch in which a Republican Obamacare-overhaul bill collapsed, was replaced and then the replacement collapsed, Trump told reporters that he was going back to a strategy he had pitched on the campaign trail: Let Obamacare fail, then rebuild the health-care system once it does.

But health care is not like an Atlantic City casino. Its failure would have massive, hard-to-predict repercussions. And the negative effects of that almost certainly unpleasant fallout would land largely at the feet of Trump and his party.

The Kaiser Family Foundation has asked a related question in polling in the past several months. Survey respondents were asked which is closer to their point of view: that Democrats own the problems of Obamacare because they wrote the bill or that Republicans do because they control the Congress and the White House. Each time the question was asked, about 6 in 10 respondents said that the problems are now the responsibility of the GOP.

Fewer than a third of respondents say that Obama and the Democrats are to blame.

Interestingly, this is one of the few areas where there isn’t a big partisan split. That Republicans would be to blame for problems is a position held by a majority of Democrats, as expected — but also a majority of Republicans and independents.

Trump’s position seems to be that he can, through sheer force of salesmanship, change America’s mind.

In January, he argued that Democrats bore the blame for Obamacare’s problems, a position he hinted at on Tuesday.

(Never mind that in 2013, he declared that his party would own the policy if it didn’t kill it with a government shutdown looming.)

Clearly Trump falls into that 30 percent of Americans who think Democrats should bear the blame.

But the Kaiser question is in the abstract. A collapse of the health-care system as currently structured might mean millions of Americans without the ability to buy mandated insurance policies — or policies that have become so expensive that they are prohibitive for people to buy.

Mind you, that’s not the path that we’re on now. The Congressional Budget Office has repeatedly indicated that the Obamacare market is “stable in most areas” — not, as Trump often argues, in a “death spiral.” What could weaken that stability, the CBO wrote in May, was the withdrawal of insurers from marketplaces based on “lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments.” Margins for insurers hit a new high in the first quarter of this year, but the health-care debate — and Trump’s repeated threat to withhold payments to insurers — means that the other risks are very real. (Blue Cross Blue Shield in North Carolina cited the political turmoil and Trump’s threat as factors for its more-than-expected increase in premiums in 2018.

If the marketplace becomes substantially disrupted and Americans face spiking insurance costs or the inability to enroll in coverage, it’s hard to see how the party that currently runs Washington will escape blame. Trump is confusing Obamacare in the abstract with a particular-thing-that-would-have-happened. It’s a bit like the captain of the Titanic intentionally ramming an iceberg and assuming that the passengers’ families would blame the people who built the ship.

Tweets like this probably won’t cut it.

After all, the Senate bill that failed required only 50 votes for passage — but the Republican majority couldn’t secure them.

What Trump is promising to members of his party is that turning the knobs that could prompt Obamacare to start to tailspin would lead America to blame the people who made the plane, not the ones now piloting it. He’s promising, in essence, that his salesmanship can convince America that his political opponents bear the blame for the crash.

That’s an awfully risky promise for Republicans to accept from a guy who can’t even get half the country to say he’s doing a good job.