Trump vs. the Affordable Care Act—Now What?

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When you f**k with people’s health care, um, they tend not to like it. Will Donald Trump’s attempted f**kery by way of executive order actually stick to his own legacy while he tries to diminish Barack Obama’s? (Photo Credit: Brennan Linsley/AP)

When Barack Obama stepped into office in 2009 and began signing executive orders, he was criticized vociferously by conservatives, Republicans, and the combination therein. Never mind that they were primed to look for any reason to hate on Obama—Sean Hannity even took time out to assail #44 for his choice of condiments on his burger, of all things—but the suggestion was that Barack Obama was content to rule by fiat rather than work with Congress, Democrats and Republicans alike. Not one to hold his feelings and opinions back, Donald Trump was among these vocal critics, regularly attacking the man who would eventually hand him the keys to the White House, so to speak, on matters of playing golf and issuing executive orders. Of course, now that “the Donald” is President, he spends more than a quarter of his time golfing—usually at one of his resorts and thereby costing the taxpayer while lining his own pockets. As for executive orders, Trump’s pace thus far is likewise hypocritical. As of this writing, Trump’s 49 executive orders puts him on pace to sign the most orders in 50 years. Now if only he could fill his Cabinet with this much alacrity and zeal!

This most recent Trump executive order is especially notable in the context of the apparent war waged by the GOP on affordable health care in the United States of America, as it specifically addresses the Affordable Care Act. Broadly speaking, the executive order is aimed at allowing small businesses skirt some of the requirements currently imposed by the ACA. One of its major functions is to ease the rules that govern the creation of “association health plans,” which are plans that can be created by small businesses across state lines through trade groups, theoretically designed to drive down insurance rates by increasing competition. As Bruce Japsen, a Forbes contributor, tells, however, AHPs don’t have a track record of great success. The idea of association health plans has existed for decades, but according to Japsen via those who have studied interstate insurance sales over time, these plans have not met with much efficacy. AHPs have been prone to cost-cutting methods which have also meant cutting the quality of service, not to mention they’ve been subject to their fair share of fraud and insolvency. As critics have outlined, there is increased risk of “essential health benefits” no longer being covered by these new plans, as well as fewer options and higher premiums on the individual market. In addition, in states where buying insurance across state lines already exists, plans that make use of this provision are sparse to nonexistent. As Japsen details, this “hasn’t worked in large part because plans haven’t wanted to spend the money contracting with more doctors and hospitals in areas they have no enrollees.” For consumers and insurers alike, the prospect of association health plans has been a losing proposition.

The other major function of President Trump’s executive order is to increase the limits by which insurance plans can be considered short-term insurance plans. Effectively, it would be undoing an Obama-era provision that narrowed the window to three months of eligibility for these plans—which are intended for people expected to be out of work only for a limited period of time. By expanding the period of time that these plans can be used by employers, which tend to offer fewer essential benefits and involve higher out-of-pocket costs, it is that much more likely that healthier people will use short-term plans to circumvent the ACA. With respect to the ACA plans, this likely will lead to higher premiums, fewer insurers, and thus, less competition and stability. Other than that, though, a great idea, eh?

Overall, the theme is one of offering less expansive health coverage while at the same time increasing premiums for the most vulnerable Americans, namely the elderly, the poor, and the sick—often one and the same given a previous inability to accrue savings or the simple fact of not having a steady source of income beyond supplemental avenues—and decreasing the number of available insurance options, all under the guise of cutting costs and creating competition among insurers. In other words, Trump’s executive order is not all it’s cracked up to be, which explains why opposition to it is so widespread, including from consumer groups, physicians groups, policy analysts, and state officials. While the very legality of this executive order has yet to be decided, as with a number of Pres. Trump’s directives in their original form, and while the order merely provides direction to government agencies with respect to how they should interpret elements of health care touched by the Affordable Care Act to alleviate financial burdens, it seems apparent that Trump is not altogether concerned with the long and short of what his own authorization contains, but rather merely that this will eat away at a significant portion of Barack Obama’s legacy as POTUS. This is to say that Donald Trump evidently is OK with ending the so-called “mess” that is ObamaCare whether it works or not, Tweeting as Americans threaten to slide down into the abyss.

And this is before we even get to the issue of ending Affordable Care Act subsidies. President Trump stated that he plans to end federal payments to insurers as part of cost-sharing reductions that allow consumers to manage their deductibles and out-of-pocket expenses. The timetable for this shift is—surprise!—unclear, although some believe the cutoff will arrive next month. Coincidentally—though likely not coincidentally—open enrollment for coverage through ACA marketplaces is set to begin in a few weeks. Accordingly, Trump has been charged with figuratively “throwing a bomb” into these marketplaces, the fallout of which would stand to disproportionately affect Americans in the states that voted him for in the presidential election. Thanks for your support, guys, but it’s time for you to pay more or die! It’s telling when Democrats are on the same side as health insurance companies on an issue, and when congressional Republicans are urging the President to continue these subsidies despite them being challenged in court by House GOP members. Speaking of the courts, a number of states have sued to stop the removal of these subsidies, and more lawsuits are apt to come from insurers and other concerned parties. Donald Trump’s move to essentially “gut” the Affordable Care Act may be his way of trying to push responsibility onto Congress and various federal agencies like the Department of Health and Human Services, but it comes with real consequences. Might these consequences also come in the form of political damage for Trump and the rest of the GOP? Though his popularity has steadily declined, Trump has yet to really feel the brunt of strong criticism for his poor decision-making, especially among his supporters. Then again, if he f**ks with their health care, all bets might be off.


On the specific subject of these ACA subsidies—the main reason for the furor over Pres. Trump’s decision, at that—the debate seems to be a striking example of what is technically correct and what is morally correct. I alluded to the notion earlier that House Republicans have challenged the legitimacy of the subsidy payments. As a federal court decided, this challenge has merit. The Obama administration approved Cost Sharing Reduction (CSR) subsidies that go directly to insurers in an effort to reduce the bottom line of the consumer. As the court found, however, this violates the Constitution because it involves the executive branch making appropriations and bypassing Congress to do it, a violation of the separation of powers doctrine fundamental to the idea of checks and balances. Additionally, by giving money to insurance companies, this, in theory, materially benefits them, though the companies allege consumers are the primary beneficiaries. It’s no small potatoes, either—we’re talking billions of dollars here. This is the aspect of the subsidies that Donald Trump, friend of the American people and of the little guy, has latched onto in explaining why he is choosing to end these subsidies so abruptly and why now. You know, because if this were truly a principle-of-the-thing kind of thing, wouldn’t you have ended the subsidy payments when you first got into office? Unless you were convinced that you and your Republican cronies were going to ram a repeal of the Affordable Care Act down our throats before it even got this far? I mean, did you even think about the matter this hard?

So, yes, CSR subsidies may not be technically constitutionally correct, and conservative publications and thinkers which shamelessly defend the President have already hailed this directive as a defense of law and order in these United States. Never mind his myriad potential other constitutional offenses and conflicts of interests—in the arena of what-have-you-done-for-me-lately, Trump is A-OK. On the other hand—and this is the critical point in all this discussion of the Affordable Care Act, subsidies, and making affordable health care less a luxury and more a right (as it should be)—to yank away these subsidies suddenly like a rug under the feet of average Americans, as many would argue, is not the morally advisable course of action. Even Trump’s boasting on Twitter about hurting the stocks of health insurers smacks of an emotional disconnect with the consumer. While few would or should feel bad for corporations, which do not have feelings and don’t exist outside of the world of legal entities, having share prices dive affects shareholders, and could even result in employees within these companies losing jobs. There are real people behind the dollars and cents that go up and down. It’s not a game.

Of course, Donald Trump’s moral compass has long been suspect in its utility as a guide, if not completely broken. As such, we perhaps shouldn’t be surprised he would put himself at odds with the needs of his constituents, let alone the wishes of his Republican comrades in his adopted party, many of whom are likely to face stiff contests in 2018 in midterm elections, let alone GOP primaries leading up to the big shebang. Already, if Roy Moore’s defeat of Luther Strange in Alabama to fill the vacancy left by Jeff Sessions when he became Attorney General is any indication, “establishment” candidates/incumbents are facing a voting public that has soured on Congress’s well-established tradition of being inefficient and ineffectual in representing the needs of the working class and middle-class America, demographics on the seeming decline as they are. Thus, while Trump himself may be safe given that incumbent Presidents seeking re-election tend to be victorious and that Democrats seem unlikely to unite behind a sufficiently progressive candidate, if voters connect the dots between failures in health care and a faulty GOP health care strategy, contested seats may not be as secure as Republican congressional leaders might otherwise be led to believe.

Donald Trump, in his usual grandiose style, stated that there is no more such thing as ObamaCare, that it is “dead” and “gone.” Also as usual, his rhetoric is misleading. Trump’s executive order and his intended end to subsidized lower insurance costs through the Affordable Care Act would be devastating to insurance marketplaces, an effect exacerbated by the timing of this decision/its proximity to open enrollment. However, without a satisfactory plan waiting in the wings, #45 is invoking the name of congressional Democrats and Republicans and insisting that the two sides work together for the sake of a “short-term fix.” This is not how good political leaders operate: by coercing lawmakers into action, including those of his own adopted party, and encouraging a standoff between the executive and the legislature. It’s bullying, and it’s a refusal to own his own failure in being unable to negotiate a deal that would see a credible surrogate for the ACA. Meanwhile, at least 18 states are suing to block a halt to the CSR subsidies, with insurance premiums and federal budget deficits set to increase significantly if Trump’s plan—if you can even call it a plan—comes to fruition. That’s not just bad for insurance companies and the senators who have counted them among their biggest donors. That’s bad for the entire nation.

In the name of his own vanity, President Donald Trump aims to throw a wrench into the workings of the Affordable Care Act as a means of somehow erasing Barack Obama’s legacy. Obama’s historic presidency, however, is more than just the sum of the legislation he signed into law, and while Obama was far from perfect as leader of the country, he is light-years ahead of Trump in intellect, moral fiber, and professionalism. As aforementioned, thus far, not much in the way of negative associations have stuck with Teflon Don, during his tenure as POTUS or, for that matter, in light of his overrated track record as a businessman and entrepreneur. Perhaps through the lens of TrumpCare, though, the shine on his unnaturally orange visage will begin to fade.

Are the Democrats’ Hopes for 2020 Already Doomed?

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It is happening again. The Democrats are employing the same empty strategy that lost them the last election. (Photo Credit: Andrew Gombert/EPA)

Before I begin, let me acknowledge that, on some level, I already hate myself for writing a piece about the Democratic Party’s prospects for reclaiming the presidency in 2020 when there are other critical elections happening prior to then, namely 2018 mid-terms, which, at this rate, party leadership should be concerned about in merely holding onto what they have let alone regaining seats previously lost. Still, when you have someone as unpopular as Donald Trump in the White House, with people counting down the days until his first term is over, it is perhaps never too early to be thinking ahead to the next presidential election and how eight years of President Trump might be circumvented.

According to Musa al-Gharbi, Paul F. Lazarsfeld Fellow in Sociology at Columbia University, however, Trump’s re-election may be all but a fait accompli. Writing for The Conversation, an independent source of news and views from the academic and research community, al-Gharbi cites four key reasons as to why a Trump 2020 victory is not only entirely possible, but likely. Why, pray tell, is—gulp—Trump probable to be a two-term president?

1.  Voters tend to stick with the default option.

The hope here is that, because Donald Trump and his presidency have been anything but normal, convention might be summarily bucked in this regard again, but Musa al-Gharbi cites some pretty compelling evidence as to why the odds are against the orange one receiving the ol’ heave-ho, chief among them this nugget of fact: since 1932, only once has an incumbent party failed to win a second-term—that of Jimmy Carter and the Dems. To put this a different way, it’s apparently pretty hard to get yourself kicked out of the Oval Office.

2. Despite being unpopular overall, Trump is still popular with the people who voted him in.

Or, as al-Gharbi puts it, “popularity is overrated.” Despite not liking Trump and his personality all that much, many Americans are likely satisfied with the job he’s doing,—or even feel he’s exceeding expectations. I imagine some of you are reading this and are thinking, um, are we talking about the same guy here? We are, and much as members of Congress, unpopular in their own right, tend to get re-elected more often than not, Trump supporters, swayed neither by media accounts of the brewing scandal within the Trump administration nor bits of domestic or foreign policy they may find disagreeable, are liable to come out again in 2020 for their anointed candidate. All this makes for shitty news for Democratic hopefuls in 2018 and 2020. Glad I could lift your spirits, eh?

3. The Democrats don’t really seem to have a strong contender in place.

Elizabeth Warren? Cory Booker? Kirsten Gillibrand? Amy Klobuchar? Joe Biden? Michelle Obama? Hell, Hillary Clinton—again? If any of these possible names suggested by their supporters are leaders in the proverbial clubhouse in terms of viability as a challenger to Donald Trump, it’s not especially evident, nor is it clear that any of these individuals would have that strong of a chance to upend Trump if a follow-up election were held today. The Democratic Party, generally speaking, seems to be suffering from quite the crisis of leadership, with its most popular representatives either constitutionally prohibited from running again (Barack Obama) or not even a self-identifying member of the party (Bernie Sanders). Simply put, there is no galvanizing figure among the Democrats, or one that a majority of the party is willing to rally behind.

4. Yeah, about that whole impeachment idea.

If you can’t beat ’em, disqualify ’em? To be clear, for those who are not express devotees of Pres. Trump, it’s kind of difficult to imagine how he hasn’t, in some shape or fashion, disqualified himself. Be this as it may, though, Musa al-Gharbi succinctly states that Trump is unlikely to be impeached until his second term, if at all, if for no other reason than Republicans hold a majority in both the House of Representatives and the Senate—and this reality isn’t apt to change after 2018 either. Besides, the options after Trump on the line of succession aren’t all that inspiring. Mike Pence? Paul Ryan? You may as well pick your brand of poison to this effect.


So, we have multiple concrete reasons from an expert in matters of human social behavior as to why Donald Trump will probably continue to be our evil overlord in 2020 and beyond. This invites the question at the heart (and title) of this piece: are the Democrats’ hopes for 2020 already doomed? Before conceding as much, let’s first address how much is in the locus of control of Democrats with respect to why Musa al-Gharbi says Trump should win. Certainly, historical trends are beyond anyone’s reach. Unless, of course, you happen to have built a time machine, and even then, meddling in past affairs is not recommended, as numerous works of science fiction will attest to. Opinions of Trump as president would also appear to be largely outside the realm of Democratic influence—though many of the aforementioned key Democratic figures seem content to beat that horse to a bloody pulp by assailing Mr. CEO-President at the drop of a hat. As for impeachment, meanwhile? The Dems simply don’t have the majorities needed to force the issue. After all, if voters who don’t possess donor-placating motivations aren’t moved to forsake Pres. Trump, there’s a snowball’s chance in Hell Republicans in Congress, yanked to and fro by wealthy conservatives and corporate industry leaders like puppets on strings, will act against #45, particularly when, despite all the tumult of this presidency, they, by and large, have been able to further their pro-business, anti-poor-people-and-minorities agenda.

This leaves reason #3—the Democrats’ rudderless approach to winning elections—as the primary area where the party can control its own destiny. While the crisis of leadership that evidently plagues the Dems is a big problem, perhaps an even larger issue is found in the overall message that leadership within the party is trying to convey. Matt Taibbi, who consistently writes excellent articles for Rolling Stone magazine, recently addressed the proverbial brick wall against which Democrats have been banging their heads, electorally speaking. His latest essay comes after a special election to fill the vacated seat in the House of Representatives for the state of Montana’s at-large congressional district after Ryan Zinke was confirmed as Secretary (and Destroyer) of the Interior. You may have heard about this one. Democrats were optimistic about the prospects of cowboy-hat-wearing singer-songwriter and upstart politician Rob Quist garnering a victory in a red state like Montana and sending a message of repudiation to Donald Trump and the GOP regarding their regressive path forward for America. They were especially encouraged about Quist’s chances after Republican candidate Greg Gianforte, you know, assaulted a reporter after being pressed on the subject of health care and was charged with as much.

And yet, Gianforte ultimately prevailed. We should bear in mind that there are some mitigating circumstances in the results of this special election. Indeed, early voting did count for a significant part of the final tallies, though if you’re thinking this is a reason to dismiss early voting wholesale, you’d arguably be throwing the baby out with the bathwater. Taibbi highlights other reasons that have already made the rounds during the post-election Democratic Party sobriety hour, including lack of an infrastructure for the party in Montana, being outspent by conservative PACs, and our good friends gerrymandering and right-wing media. Still, Rob Quist’s loss in spite of bad behavior by his Republican counterpart is not the first of its kind in recent memory, one more exhibit in a disturbing series of GOP wins with seemingly little thought given to character next to overarching ideologies. Taibbi details this trend:

There is now a sizable list of election results involving Republican candidates who survived seemingly unsurvivable scandals to win higher office. The lesson in almost all of these instances seems to be that enormous numbers of voters would rather elect an openly corrupt or mentally deranged Republican than vote for a Democrat. But nobody in the Democratic Party seems terribly worried about this.

Gianforte is a loon with a questionable mustache who body-slammed Guardian reporter Ben Jacobs for asking a question about the Republican health care bill. He’s the villain du jour, but far from the worst exemplar of the genre. New Yorkers might remember a similar congressional race from a few years ago involving a Staten Island nutjob named Michael Grimm. The aptly named Grimm won an election against a heavily funded Democrat despite being under a 20-count federal corruption indictment. Grimm had threatened on camera to throw a TV reporter “off a f**king balcony” and “break [him] in half … like a boy.” He still beat the Democrat by 13 points.

The standard-bearer for unelectable candidates who were elected anyway will likely always be Donald Trump. Trump was caught admitting to sexual assault on tape and openly insulted almost every conceivable demographic, from Mexicans to menstruating women to POWs to the disabled; he even pulled out a half-baked open-mic-night version of a Chinese accent. And still won. Gianforte, Trump and Grimm are not exceptions. They’re the rule in modern America, which in recent years has repeatedly demonstrated its willingness to vote for just about anybody not currently under indictment for serial murder, so long as that person is not a Democrat.

The list of winners includes Tennessee congressman Scott Desjarlais, a would-be “family values” advocate. Desjarlais, a self-styled pious abortion opponent, was busted sleeping with his patients and even urging a mistress to get an abortion. He still won his last race in Bible country by 30 points.

One wonders if even the serial murderer bit would be enough to disqualify a Republican these days—especially if he or she went around killing liberals or minorities. Furthermore, while Matt Taibbi acknowledges all of the above justifications were, in part, factors in why Greg Gianforte triumphed and Rob Quist was left to sing a sad country song (aren’t they all sad, come to think of it?), as he argues, this rationalization/moral victory business is also indicative of a self-destructive mentality within the Democratic Party. Taibbi explains further:

A lot of these things are true. America is obviously a deeply racist and paranoid country. Gerrymandering is a serious problem. Unscrupulous, truth-averse right-wing media has indeed spent decades bending the brains of huge pluralities of voters, particularly the elderly. And Republicans have often, but not always, had fundraising advantages in key races. But the explanations themselves speak to a larger problem. The unspoken subtext of a lot of the Democrats’ excuse-making is their growing belief that the situation is hopeless – and not just because of fixable institutional factors like gerrymandering, but because we simply have a bad/irredeemable electorate that can never be reached.

This is why the “basket of deplorables” comment last summer was so devastating. That the line would become a sarcastic rallying cry for Trumpites was inevitable. (Of course it birthed a political merchandising supernova.) To many Democrats, the reaction proved the truth of Clinton’s statement. As in: we’re not going to get the overwhelming majority of these yeehaw-ing “deplorable” votes anyway, so why not call them by their names? But the “deplorables” comment didn’t just further alienate already lost Republican votes. It spoke to an internal sickness within the Democratic Party, which had surrendered to a negativistic vision of a hopelessly divided country.

This sort of us-versus-them rhetoric has long since been established by and understood of the Republican Party. Blame the welfare seekers taking advantage of the system. Blame the erosion of American values. Blame illegal immigration. Blame terrorism. I don’t wish to give Donald Trump too much credit in this regard—in fact, I wish to give him little to none for exploiting these factors—but he did commit to the GOP playbook and ride out the electoral storm unapologetically all the way to the White House. For the Democratic Party, however, a party that touts its inclusiveness, subscribing to the belief that certain segments of the electorate are, at best, not worth the effort, and at worst, irredeemable, seems, if not a betrayal of its core values, then a poor way to distinguish itself from the kind of Republican Party which makes closing America’s open door to refugees of war-torn nations and closing bathroom doors to the transgender community some of its top priorities. As Matt Taibbi offers, “Just because the Republicans win using deeply cynical and divisive strategies doesn’t mean it’s the right or smart thing to do.” In saying as much, he points to how Barack Obama campaigned in red states, even when facing racist rhetoric or when assured of losing in the general election, marking a stark contrast between his approach and that of Hillary Clinton, content to play it safe and keep pandering to the Democratic base.

At the core of the Democrats’ woes, though, and where I feel Taibbi’s analysis hits the nail on its head, is in their strategic and thematic miscues. As the author keenly stresses, a platform based almost exclusively on Trump/Republican negatives is neither a message nor a plan, explaining why the Democrats “have managed the near impossible: losing ground overall during the singular catastrophe of the Trump presidency.” Furthermore, the party appears to lack the commitment to help mobilize people to the polls. Taibbi closes his piece with these thoughts:

The party doesn’t see that the largest group of potential swing voters out there doesn’t need to be talked out of voting Republican. It needs to be talked out of not voting at all. The recent polls bear this out, showing that the people who have been turned off to the Democrats in recent months now say that in a do-over, they would vote for third parties or not at all. People need a reason to be excited by politics, and not just disgusted with the other side. Until the Democrats figure that out, these improbable losses will keep piling up.

This, if you ask me, was one of the most glaring weaknesses of the Hillary Clinton presidential campaign: rather than focusing on why we shouldn’t be voting for Donald Trump—and if you didn’t see why by November, you probably never were going to see it, let’s be clear—a more compelling case should have been made for why she (Hillary) merited your vote. That is, if you weren’t sold by the “first woman President” angle, and if you were tired of voting for the so-called lesser of two evils (by now, we all should be), there should have been a different or modified narrative for her sake. The polling Taibbi cites of voters increasingly disenfranchised with the Democrats and yet more willing to choose a third-party candidate or none at all should scare the living daylights out of party leadership, as should the notion that younger and more liberal Dems are openly discussing the formation of a new party such as the People’s Party to more authentically represent the country’s needs. Granted, we might not expect the results of a splintering of the Democratic Party to bear fruit in the short term, if it even gets off the ground and is sustainable, but at what percentage of a “lost” vote will the Democratic brass truly begin to take notice and action? 10%? 15%? Or will they remain aloof and/or continue to deflect from undertaking genuine reform?

Should the Democrats be disheartened at not winning the special election in Montana? Given the state’s political leanings, no, not really. That said, a loss is still a loss, and if Democrats are looking for some sense of momentum heading into 2018 or 2020, they’ve still got a wait on their hands for that potential pivotal moment. Moreover, if they’re waiting on Donald Trump and other loose cannons to self-destruct, they’ve got a yet longer wait. Simply put, playing the game of not—not losing, being not-Trump or not-Republicans—is not working. Even if a sense of false hope is what Trump and Co. are giving their supporters, at least they are giving them something on which they can hang their proverbial hats. “Make America Great Again.” It may not mean much to those of us who condescend against its very logic, but to those who believe in it as a promise, it means a great deal. As for the Democrats, who is their inspirational leader? What is their rallying cry? Though mid-terms and the next presidential election may seem remote to many of us, if the Dems don’t figure out answers to these questions or think about how to better reach out to underserved portions of the electorate, they and members of the Resistance will still have their work cut out for them in three-and-a-half years’ time.