Now that Trumpcare has failed, it is feared that Trump and Price will do everything in their power to make their statements that “Obamcare will implode” come true. And Trump and Ryan made very clear they will try to blame Democrats if and when that happens. Trump specifically said that “Democrats own” Obamacare and that Pelosi and Schumer were the big losers in the failure of Trumpcare, despite the GOP making no effort to include Democrats. This does not even pass the Trump laugh test. But the chances that the GOP could severely damage Obamacare even without a successful repeal vote has been a possibility ever since Trump was elected and I hope the Democrats are prepared.
Incredibly, Trump and Ryan both stressed that Obamacare would implode and that it would prove to the Democrats just how flawed the program is. Trump and Ryan seemed content to let that happen and will desperately be trying to ensure that Democrats take the blame for that failure. Then, theoretically, Democrats will be forced to negotiate a new health care bill with Republicans in order to respond to Obamacare’s collapse. Trump laid out that strategy in a tweet this morning, “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!”
Frankly, I have to believe this stance is untenable. First of all, if you believe the CBO, which apparently many Republicans don’t, Obamacare is not going to collapse. But, if you are Trump and Ryan and you control Congress and the White House, it’s seems inconceivable that you can simply let Obamacare fail, especially after you see the resistance just displayed when the GOP tried to take that health insurance away. And if that really is their plan, the attacks on their approach to leadership and governing are ready-made. It is the equivalent of letting a bomb explode and saying that things will be better when we rebuild. Even Democrats should be able to make Trump and the GOP pay for that approach to governing.
It is nice to see that Democrats are already running ads targeting 14 vulnerable Republicans who voted for Trumpcare while it moved through various House committees, tying them to especially horrible aspects of the bill. And Trump himself left an opening for Democrats when he almost begged the Democrats to come to the table and help craft another health care bill.
One way to insulate Democrats from the blame for a possible Obamacare collapse and actually call Trump’s bluff is to offer a specific bill to solve some of the issues with Obamacare. That plan should include the Medicare opt-in for those 55–64. This would reduce the number of older, sicker enrollees and improve the risk pool of the insured pool that remains, reducing premiums and deductibles. In those counties where there is only one provider, offer Medicare as a second alternative insurer. To reduce the cost of prescription drugs, allow Medicare/Medicaid to negotiate prices with pharmaceutical companies. Use the savings from that prescription drug change to increase subsidies and extend those subsidies farther up the income ladder. Vox has listed some other progressive ideas that would shore up Obamacare and actually save federal money. Some of these are even proposals that Trump has mentioned in the past. Democrats should also stress that time is of the essence as insurers will have to decide on their exchange participation for 2018 late next month. If Trump and the GOP refuses to confront the issue before then, Democrats should lay the groundwork for blaming them for whatever happens in 2018.
In addition, Democrats need to pressure Trump on fighting a case brought Republicans in Congress over the funding for subsidies for low-income earners. Congress believed that money was improperly authorized and the Obama administration had fought that in court. When Republicans actually thought they could repeal Obamacare after the election, they asked for a delay in the court proceedings. When the case restarts, Trump will have to decide whether he will fight the case or let the funding for those subsidies lapse. That would be a major blow to health insurers and could really damage some exchanges. Democrats need to make their energized base aware of this and pressure Trump to not only continue to fight this case but adopt the sensible solutions that Democrats have offered.
While congressional Republicans will dismiss all these items out of hand, Trump might actually buy in. If he doesn’t, then Democrats can attack Trump and the GOP for not only “knowing” that Obamacare will implode but also triggering that implosion and, despite paying lip service to a bipartisan solution, show that Trump and the GOP are still unwilling to work with Democrats.
Democrats should also again release their plan for infrastructure spending, again harping on Trump to take advantage of a chance to gain bipartisan support for one of his campaign promises. Democrats could position this as an easy win for Trump, showing he does have the capacity to actually get things done.
Democratic proposals on health care with constant support from its leaders will drive a wedge between Trump and Republicans. Republicans in Congress have no interest in getting anywhere near healthcare again anytime soon. And they also have no interest in infrastructure spending, simply because it’s government spending. Trump, however, may actually be interested in working with Democrats on these issues. If he is, it will pit Trump against the far-right Republicans in Congress. If he isn’t, it puts lie to his stated desire for bipartisan solutions and provides an easy avenue for Democrats to attack. Either way, Democrats get some traction. In addition, any time that Democrats can get Trump or Republicans to spend revisiting healthcare or considering infrastructure is time not spent moving forward on tax reform, meaning cuts, and other items on the GOP agenda.
There is one final point to make on Obamacare. Kansas, yes Kansas, that tax-cutting, supply-side loving disaster of a state, voted to opt-in to Medicaid expansion. A newly elected bloc of moderate Republicans have joined with Democrats in the state to help pass Medicaid expansion in the Kansas House and the Kansas Senate is expected to take up the issue on Monday, having passed the bill out of committee just yesterday. If the Senate passes the bill, it will probably be vetoed by the departing, intransigent, and incredibly unpopular Governor Sam Brownback and it remains to be seen whether the Senate will be able to muster enough votes to override that veto or what Brownback’s successor will do.
Now that Obamacare repeal is definitely off the table, I would expect that those states that resisted Medicaid expansion will quickly begin to finally adopt it. As Paul Ryan bluntly said, Obamacare is here “for the foreseeable future”. That being the case, states that refuse to adopt Medicaid are simply leaving billions of federal dollars on the table for no good reason. There is simply no longer even a political advantage to refusing to expand Medicaid anymore. And further Medicaid expansion will effect red states overwhelmingly. That makes the plan of Trump, Ryan, and Price to “help” destroy Obamacare actually even more risky, as it will be their constituents who will stand to lose the most.