He Now Owns It

Coming out from behind the shadows of meaningless tweets and hidden threats to sabotage the Affordable Care Act (ACA, which is known as Obamacare), Donald Trump has now officially taken steps to insure that the ACA will fail. With two new executive orders and in defiance of the plain intention of the statute itself – at a time when the ACA was beginning to stabilize and actually work – the President is pulling the financial underpinnings of the law out from under the program. If courts do not rule against these efforts, the ACA will for the most part collapse. But by issuing these executive orders, his dream of being able to blame President Obama and the Democrats – something Trump and his base still cling to – also just died. The collapse of the ACA is clearly going to be the fault of Trump, Trump, Trump.

“President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday [10/12]. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers.

“The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own.

“Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums and may pull out of the insurance exchanges created under the Affordable Care Act if the subsidies were cut off. Known as cost-sharing reduction payments, the subsidies were expected to total $9 billion in the coming year and nearly $100 billion in the coming decade.

“‘The government cannot lawfully make the cost-sharing reduction payments,’ the White House said in a statement… It concluded that ‘Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.’” New York Times, October 12^th.  Under these orders, states can now apply to the federal government for waivers to implement their own plans, expected to have lower premiums but with significantly lesser coverage (opening the door for higher premiums for those with preexisting conditions) and unaffordable deductibles. The pulling of the subsidies pretty much destabilizes the insurance market, and we can expect fewer carriers to stay in the healthcare exchange system… with higher prices for those companies electing to remain.

Bottom line, if you do not have healthcare through your work – unless you live in a state that cares – and you are not earning enough to afford real coverage, when it comes to medical care, you are probably screwed. And in the developed world, the United States of America is the only country where that can happen.

These orders also represent an interesting and hopefully legally incorrect interpretation of the plain meaning of the ACA, but that issue is well underway within the judicial process based on a 2014 federal case (United States House of Representatives v. Burwell) filed by GOP Republicans in the US District Court for the District of Columbia.

In September of 2015, “a federal district court in Washington, DC ruled that the House of Representatives had standing to bring claims against the Obama administration regarding healthcare spending under the Affordable Care Act. That is, the court found that the House could sue the administration for spending billions of dollars on the ACA subsidies that Congress allegedly never approved. The ruling is the first to allow the House to sue an administration regarding its spending ability.” Thehealthlawpulse.com, September 10, 2015

But fault may be irrelevant if the ACA fails. That could literally force the “repeal and replace” GOP movement to provide what Trump hopes is the “only alternative.” Trump isn’t running in the mid-terms; it’s a Congressional election. The full impact of these executive orders, particularly if they are stayed by the courts pending higher court resolution, might not be felt by those 2018 elections, although carriers leaving the system could have an immediate result.

“Most of the changes will not occur until federal agencies write and adopt regulations implementing them. The process, which includes a period for public comments, could take months. That means the order will probably not affect insurance coverage next year, but could lead to major changes in 2019.” New York Times. After the mid-terms and late enough that the full impact might not roil American until 2020 or beyond… when the next presidential election will take place.

But negative reaction to these executives order was quick in coming… from both sides of the aisle, noting that even in some pretty key GOP Congressional districts, the impact on local constituents could be devastating. “In a joint statement, the top Democrats in Congress, Senator Chuck Schumer of New York and Representative Nancy Pelosi of California, said Mr. Trump had ‘apparently decided to punish the American people for his inability to improve our health care system.’

“‘It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,’ they said. ‘Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.’

“Lawmakers from both parties have urged the president to continue the payments. Mr. Trump had raised the possibility of eliminating the subsidies at a White House meeting with Republican senators several months ago. At the time, one senator told him that the Republican Party would effectively ‘own health care’ as a political issue if the president did so.

“‘Cutting health care subsidies will mean more uninsured in my district,’ Representative Ileana Ros-Lehtinen, Republican of Florida, wrote on Twitter late Thursday [10/12]. She added that Mr. Trump ‘promised more access, affordable coverage. This does opposite.’” New York Times. In the end, the United States is not a particularly good place to live if you are in the middle and lower income brackets or if you are a member of a racial or religious minority on the white traditionalist target list… and if you are poor, God help you… a parallel to what it is like living in Puerto Rico right now.

I’m Peter Dekom, and for too many Americans, day-to-day life in the United States seems increasingly to violate the Eighth Amendment’s ban on cruel and unusual punishment.