Trump Signs Executive Order To Kill Obamacare

Having failed to pass legislation to repeal Obamacare, Trump, with apparent complicity from his GOP supporters in Congress, has set out to destroy it by executive authority. His failure to guarantee that the CSRs will be paid to insurance companies is already driving up insurance rates in almost every state in 2018. And Trump's latest executive order to allow the creation of "association health plans" (AHP) that will be able to offer cheap insurance with none of the essential health benefits  required by Obamacare, such as coverage for pre-existing conditions, is a dagger at the heart of Obamacare.

Already, for 2018, Trump's maneuvers on the CSRs have added over 12% to the premiums in California. In New Hampshire, insurance premiums are increasing 64%, along with hikes in deductibles and co-pays. These are states with healthy ACA exchanges where the markets were stable before Trump and the GOP started screwing around with the program.

If, as expected, there is a mass exodus of healthy people from the ACA exchanges to these AHPs, it will effectively destroy Obamacare. Insurers participating in the ACA exchanges will still be required to insure people with pre-existing conditions but, with the pool of healthy people substantially lowered, the costs of participating in the exchanges will just be too high. They will exit the exchanges for 2019, leaving Obamacare essentially an empty shell.

Kevin Drum believes that this is essentially an extortion attempt by Trump to get Congress to act, that the threat of over 20 million Americans losing access to real healthcare will get the Democrats to agree to some Republican plan to keep Obamacare from imploding. I'm not so sure. I think the failure of Congress to act made Trump ask what he could do to blow up Obamacare on his own and this is the tactic that Price came up with before he had to leave on his private jet. And, as we saw with the votes to repeal Obamacare, there are plenty of Republican members who would be happy to do nothing and let Trump succeed. I don't see a big push from Republicans to come up with any alternatives.

After Trump's election, I wrote that the GOP could destroy Obamacare without even a vote in Congress. Merely creating enough uncertainty throughout 2017 would force insurers to raise premiums and potentially exit the exchanges in 2018. With Trump's help, Republicans have effectively raised premiums but they didn't force an exodus from the exchanges. Today's executive order is that next attempt to accomplish that.

The order will take time to go through the rule-making process, possibly taking up to a year or more. Democrats need to use that time to educate the public about the stealth attack on Obamacare and build an effective defense. That will mean tying the process up in the courts, potentially linking a rollback of the executive order to the debt ceiling, or simply calling Trump's bluff and making his actions the litmus test of the 2018 election. Believe me, the Republican have an incredible propaganda machine. They have the benefits of voter suppression and gerrymandering. They have no doubt that they can still win in 2018 running on the propaganda line that "Obamacare is collapsing". Though they will have caused it, they will actually be right. Do Democrats have an effective strategy for fighting back?