Apparently, President Donald Trump didn’t learn much from the first time he did it, because he is once again leading his party over a cliff on health care.
The day after the Justice Department launched a surprise attack on the Affordable Care Act, seeking to overturn the entire law, the president breezily declared Tuesday on Capitol Hill: “The Republican Party will soon be known as the party of health care. You watch.”
So here we are again. After years of promising to “repeal and replace Obamacare,” Republicans learned in 2017 that coming up with an alternative to the law was harder than it looked. Or as Trump infamously put it: “Nobody knew health care could be so complicated.”
They got a flimsy bill through the House, but their drive to repeal the ACA died in the Senate. The blunder cost the GOP dearly. By putting the law in jeopardy, they achieved what the Democrats who passed it never could: They actually helped make Obamacare popular. The president’s party also handed its opponents the issue that, more than any other, won the House back for the Democrats in last year’s midterm elections.
Republicans were dismayed at Trump’s decision to revisit the treacherous terrain of health care. And he did it, no less, just as they were riding high with the all-clear signal from special counsel Robert Mueller’s investigation regarding Russian interference in the 2016 presidential election.
The administration was already on record as favoring a partial dismantling of the law — which, among other things, would end its guarantee of coverage for people with pre-existing conditions. But now it has thrown its support behind getting rid of the whole thing, and with no apparent plan for what to put in its place.
What would it mean if the law disappeared and things went back to the way they were before President Barack Obama signed it nine years ago?
Hardball tactic
For starters, the number of uninsured people in this country would increase by nearly 20 million, according to an analysis by the Urban Institute. That would include an estimated 15 million who gained coverage through the expansion of Medicaid in the 37 states that have done so under the ACA.
Trump may be going through this as a theoretical exercise merely to please his base. After all, the Supreme Court has already ruled twice that the key parts of the ACA are constitutional.
But it may also be that Trump believes that the hardball tactic will somehow bring Democrats to the negotiating table. If that is the case, he is making the same miscalculation he did when he shut down the government on the assumption that it would give him leverage to get the money he wanted to build his border wall.
No one would argue that the ACA has worked perfectly. And many Democrats are at risk of running too far in the other direction as they tout “Medicare-for-all,” a government-run system that would replace private health insurance.
But they are delighted to change the subject from the Mueller investigation. In the House, Democrats introduced legislation Tuesday that aims to provide additional tax credits and subsidies for families struggling to buy coverage in the ACA marketplace and strengthen protection for people with pre-existing conditions. Speaker Nancy Pelosi, D-Calif., told her members during a closed caucus: “This is a path to everything else.”
As it happens, Tuesday was Pelosi’s birthday. And Trump just handed her the best gift she could have hoped for.
Karen Tumulty is a columnist for The Washington Post.
