Donald Trump's executive order yesterday on health care policy threatens to do real harm to the individual marketplace, pushing costs higher on those who need care most. Last night, however, the second shoe dropped, and it's vastly worse.
The White House announced late Thursday that it would no longer reimburse insurers for lowering costs for customers under the Affordable Care Act, a decision Democrats condemned as "spiteful."President Donald Trump had indicated he was considering cutting off the payments in order to increase pressure on lawmakers to repeal the ACA, also known as Obamacare.
Note, for months, people involved in the health care debate have played a game of "will he or won't he?" when it comes to the president and cost-sharing-reduction payments (CSRs). That question is no longer speculative: Trump is actually stopping the payments.
Indeed, he said as much this morning on Twitter: "The Democrats [sic] ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!"
In other words, the president, who is effectively going to war against his own country's health care system, is moving forward with a plan that's likely to hurt many Americans in order to gain some kind of political leverage.
Cost-sharing reductions may seem like a fairly obscure element in the larger debate, but they're a key component of the Affordable Care Act, which helps cover middle-class consumers' out-of-pocket costs. The president, motivated by spite, has turned them into a political weapon.
The Congressional Budget Office has already provided a detailed analysis of what would happen if Trump pulled the trigger on such a gambit: scrapped CSRs would lead to a 20% increase in consumer premiums by next year and a 25% increase by the end of the decade. The move is projected to force some insurers from the system altogether, leaving some Americans unable to buy coverage through an exchange marketplace.
What's more, the move is projected to push the U.S. budget deficit higher -- subsidies will have to go up to meet the higher premiums -- which means higher costs for everyone, even as the system covers fewer people. In other words, Trump has identified a change that will spend more to do less.
The CBO made all of this clear two months ago. It's not as if the president can say he wasn't warned about the adverse consequences of this ridiculous gambit. In fact, it was around this time that Sen. Lamar Alexander, the Republican chairman of the Senate committee that oversees health care policy, added that if the CSR payments end, "Americans will be hurt."
Trump is doing it anyway, indifferent to the real-world consequences. The president is making a conscious decision to undermine his own country's health care system on purpose.
All of this, of course, comes on top of the series of related steps the Republican has already taken to make it more difficult for Americans -- which is to say, his ostensible constituents -- to get the coverage and health security they're entitled to under the law.
If Trump thinks this will force Democrats to accept a GOP repeal plan, he's mistaken. If Trump thinks he can blame "Obamacare" for the damage he's doing to the system, he's misguided -- because he's taking ownership of American health care right now, forcing consumers to pay more while he sabotages the system as part of a bizarre political vendetta.
The president is taking a sledgehammer to our health care system, and he's making no effort to hide his actions. As conditions deteriorate, there will be no one else to blame.
Postscript: The administration is starting to push some odd legal argument, suggesting Trump is required to end the CSR payments, but we already know that's demonstrably ridiculous. Not only has Trump been approving these payments all year, but he also told insurers he'd keep them going indefinitely if they agreed to endorse the Republican repeal proposals.
Second postscript: It's not altogether clear if Trump's latest move is itself legal. Lawsuits from states and insurers are a certainty.