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.

You Can’t Work with Donald Trump

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Donald Trump, with various Republican senators. Probably saying something stupid. (Image retrieved from nbcnews.com.)

With all that is going on with recovery efforts after a barrage of hurricanes in the Caribbean and the Gulf of Mexico, and with a battle over the future of health care in the United States of America in its current iteration in the form of the Graham-Cassidy Bill causing divisions even within the Republican Party, it almost seems silly to be talking about whether or not players kneel during the National Anthem. Then again, man-child Donald Trump is our President, Twitter is readily available, and his base apparently values blind patriotism over most things, so here we are. Trump essentially picked a fight with those individuals who would protest by doing anything other than standing with hand over heart—and by proxy, started in with the entirety of the National Football League—even going as far as to call these would-be dissenters “sons of bitches” and suggesting they should be fired. The NFL, meanwhile, through statements released by commissioner Roger Goodell and various owners, as well as through on-field shows of solidarity including kneeling, sitting, locking arms, and even remaining in the locker room during the playing of the Anthem, took Trump to task for his divisive rhetoric. These sentiments echo those of a separate fight picked with Stephen Curry and the Golden State Warriors of the National Basketball Association regarding whether or not he and they would honor the invitation to the White House customarily afforded to the champions of their sport. After it became apparent Curry and the Warriors would not be attending, Trump assailed them on Twitter and disinvited them—you know, despite the idea they already said they weren’t going. YOU CAN’T QUIT—YOU’RE FIRED! DO YOU HEAR ME? YOU’RE FIRED!

What was especially significant about this turn of events regarding the NFL’s repudiation of Donald Trump’s off-color language is that admonishment came not only from those players who assumed the distinction of being the target of the President’s ire and their coaches, but from those individuals who had previously indicated their support for Trump during the presidential campaign. Rex Ryan, who appeared with Trump at one or more campaign stops in New York state (Ryan previously coached both the New York Jets and the Buffalo Bills) and is now an analyst in ESPN’s employ, indicated he was “pissed off” by Trump’s comments and that he “did not sign up for” the kind of shenanigans in which Trump was engaging. This line of discussion, however, prompted some curious reactions on social media and even from his fellow on-air personalities (for example, see Randy Moss’s face when hearing Ryan reveal he voted for Donald Trump). A number of critics highlighted the notion that Rex Ryan evidently signed up for a man leading the country who has denigrated Asians, the disabled, environmentalists, the LGBT community, members of his own party, Mexicans, Muslims, veterans, and women—but calling football players a name was where he drew the line? Especially when, based on their size, these players are relatively more capable of defending themselves?

Psychologically speaking, it is perhaps unsurprising that Rex Ryan would react in this manner to the hissy-fit President Trump threw over players kneeling during the playing of the National Anthem. Tough talk and rhetoric is all well and good—until someone starts talking about you or someone you care about. Transcending the NFL and people who get paid to render their opinions on sports, however, Ryan is not the only person whose support for Donald Trump has ended with disillusion and distancing oneself from the so-called “leader” of the nation. After Trump’s response to Charlottesville and his condemnation of white supremacy were deemed to be—how shall we say this?—insufficient, his business councils were disbanded when CEOs couldn’t leave fast enough to separate themselves from his hate. When companies aren’t merely dissolving their working relationships with the Trump family, they are scaling back or outright terminating their business relationships with their litany of brands, in part thanks to targeted campaigns by members of the Resistance such as the #GrabYourWallet movement. As you might recall, months back, Donald Trump threw a whole different hissy-fit at Nordstrom for its announcement that it was phasing out his daughter Ivanka’s products from its stores—HIS DAUGHTER! WHAT A BUNCH OF MEANIES! Like with Rex Ryan and his support for Trump’s agenda up until the point of belittling rank-and-file football players for expressing their personal beliefs, all was well and good until Trump’s behavior threatened these organizations’ bottom line. As the saying goes, money talks and bullshit walks. In this instance, rather, people walk when Trump’s bullshit costs them money. After all, wouldn’t you?

If any of the above were isolated incidents, there wouldn’t be much here to discuss. Plenty of CEOs are dicks. Plenty of political leaders are dicks. Why shouldn’t Donald Trump—CEO-turned-President—be one of them? Ah, but Pres. Trump is not your average dick. The embodiment of rich white male privilege, Trump has never had to deal with meaningful consequences for his actions; even in business, some creditor or his daddy was there to bail him out. As the putative leader of the free world, meanwhile, Donald Trump is in a position that beckons diplomacy and restraint, two skills in which it is very clear at this point the man lacks proficiency because he has never had to hone them. Accordingly, for all those individuals who feel compelled to entertain Trump’s invitations to help him elaborate his policies, whether because of respect for the office of President of the United States or because they think they can manipulate him into serving their own interests, it is worth considering whether or not they truly understand what they’re getting themselves into.

Matthew Gertz, senior fellow at Media Matters for America, helps explain trying to work with Donald Trump at perhaps its most essential by keeping a running account of dealings with Trump in which #45 has publicly tried to debase or discredit the other party. Or, as Gertz, terms it, “If you try to work with Trump, he will humiliate you.” The list of instances of Trump throwing someone under the bus, getting into the driver’s seat, and backing over them again is far too long to regurgitate here. (If you really want to peruse Gertz’s ever-expanding Tweetstorm on the subject, suggested clicks are here and here.) That said, there are still, um, “highlights” to be had by which we can get a better sense of just how ill-fated any partnership with Donald Trump is owing to how self-aggrandizing this man is. Here is just a sampling of “working with Trump” looks like:

  • Trump passed over Mitt Romney for the office of Secretary of State, taking him out to dinner at a fancy restaurant and essentially having Romney publicly express his confidence in Trump as a repudiation of his earlier misgivings.
  • After Paul Ryan informed Trump he didn’t have the votes to make the GOP version of “repeal and replace” of the Affordable Care Act go through, Trump still wanted a vote. In subsequent talk of tax reform, Trump and his administration sought to take a more hands-on approach to the issue—and cut Ryan out of the picture in the process.
  • Trump regularly contradicted members of his administration and his aides regarding whether he had planned to fire James Comey as FBI director or whether he relied on the advice of deputy attorney general Rod Rosenstein before doing so.
  • Disregarding the advice of members of his business councils, Trump pulled out of the Paris climate agreement.
  • There was this time when everyone around Trump’s table was praising him out loud. Super creepy and weird.
  • Sean Spicer felt he had to resign over the appointment of Anthony Scaramucci as White House communications director—who lasted less than two weeks in that role.
  • Scaramucci, for that 10 days in his tenure, sold his business and had his marriage dissolve. Congratulations, Mooch!
  • Steve Bannon had his supposed role in helping Trump get elected diminished by Trump himself, suggesting Bannon came onto the campaign late. Bannon was gone shortly thereafter.
  • Jeff Sessions has basically eaten shit over the issue of Russia. Heaps of it.

And now there’s the whole NFL thing. People like Rex Ryan and Tom Brady and owners like Jerry Jones (Cowboys) and Robert Kraft (Patriots) lent Trump their support in advance of the election, and to satisfy his base and distract from other issues like health care and North Korea, Trump picked a fight over kneeling for the National Anthem, one which only serves to magnify the race problems that he and the League face. Thanks for your contributions, guys! Perhaps beyond being momentarily “pissed off” or “humiliated,” Ryan and Co. don’t really mind so much. After all, they got the President they wanted—or at least got the man they thought they wanted—and from the appearance of things, a conservative agenda for the White House is in place, the economy is humming along, and “America first” is our raison d’être. By the same token, however, perhaps there is just a twinkling of a spark of regret from these Trump backers that they helped create a monster. Probably not, but—what can I say?—I’m an optimist.


If non-politicians may be looking on at President Trump’s tenure with a sense of buyer’s remorse, what might congressional Republicans be experiencing? Their own embarrassment or shame? Such a question implies that these lawmakers can possess these emotions, or genuine feelings altogether. (Like Trump re Mexicans, I assume some members of the GOP in Congress are actually good people.) One individual who seems to lack the ability to express actual human sentiments is Mitch McConnell the Toad-Man, a guy who has overcome having a neck pouch to become Senate Majority Leader. Vis-à-vis Trump, McConnell has toed the party line on elements of the President’s agenda where their goals have aligned, trying to push through health care reform legislation even Donald Trump himself, the Grinch Who Stole the Election, could recognize was “mean,” exercising the “nuclear option” to require a simple majority to confirm conservative justice Neil Gorsuch for the Supreme Court, and arousing feminist ire around the country by silencing Elizabeth Warren on the Senate Floor for trying to read a letter from Coretta Scott King believed by Warren to be relevant to the appointment of Jeff Sessions as Attorney General.

In the latest chapter of the Donald Trump-Mitch McConnell relationship, the two men were perhaps strange bedfellows in the Republican Party primary in the special election for the vacant Senate seat created when Jeff Sessions was sworn in as Attorney General. Trump, McConnell, and most of the GOP establishment backed Luther Strange, an attorney and the interim junior senator from Alabama so appointed when Sessions became part of the Trump administration. Roy Moore, the challenger, is—well, Roy Moore is a special individual. Former Chief Justice of the Alabama Supreme Court, Moore’s greatest claims to fame—or, perhaps, infamy—are refusing to remove a statue of the Ten Commandments from outside his courthouse, thereby signaling his intentional blurring of the lines of separation between church and state, and his order to probate judges to refrain from issuing marriage licenses to gay and lesbian couples. So, yeah, more of that whole church-state business. For these incidents, Moore was twice removed from his role as Chief Justice by the Alabama Court of Judiciary, and based on his experience and penchant for inflammatory conduct and remarks, he was likely considered a liability by Republican leaders. Again, though, in the current political climate, Moore may just as well be seen as a godsend by many of his prospective constituents, and in the deep red state of Alabama, he looks to be in a great position to be an elected successor to Mr. Sessions despite his apparent craziness to a national audience. What’s more, despite McConnell’s signaling that he intends to work with Roy Moore should he be elected, many—including Moore himself—probably see his primary victory as a rebuke to McConnell’s brand of politics and a movement to oust centrist, ol’ fuddy-duddy Republicans like him.

Rich Lowry, writer for the New York Post, devoted a recent column to matters of Donald Trump, Mitch McConnell, Roy Moore, and the GOP’s handling of an evident insurgency within its own party. Hearkening back to the larger issue with which we began—the issue of working with Trump—as Lowry sees it, the party establishment still doesn’t understand how to do so, creating problems for both sides. Lowry explains:

The result in Alabama will render Trump even more up for grabs everywhere else. Is he going to simply move on and work with the congressional leadership on the next big priority, tax reform? Is he going to exercise the “Chuck and Nancy” option? Is he going to double down on his base and resume afflicting the comfortable of the GOP establishment as he did in the primaries? All of the above? Does he know?

Trump’s problem isn’t that he threw in with the establishment, as his most fervent supporters believe; it’s that he threw in with an establishment that had no idea how to process his victory and integrate populism into the traditional Republican agenda.

One of the many causes of the failure of ObamaCare repeal is that Republicans didn’t emphasize the economic interests of the working-class voters who propelled Trump to victory (and Trump showed little sign of caring about this himself). Out of the gate, tax reform looks to have a similar problem— the Trumpist element is supposed to be a middle-class tax cut, but it’s not obvious that it delivers one.

This gets to a fundamental failing of the populists. House Speaker Paul Ryan isn’t supposed to be the populist; Trump is. But the president and his backers haven’t even started to seriously think through what a workable populist platform is besides inveighing against internal party enemies, igniting cable TV-friendly controversies and overinvesting in symbolic measures like The Wall.

If the populists don’t like the results, they should take their own political project more seriously, if they are capable of it.

A success on taxes would provide some respite from the party’s internal dissension, yet the medium-term forecast has to be for more recrimination than governing. Whatever the core competency of the national Republican Party is at the moment, it certainly isn’t forging coherence or creating legislative achievements.

It’s no great surprise that Donald Trump and his cronies don’t have much of an idea about what they’re doing; concerning matters of domestic and foreign policy, Trump is a veritable Magic 8-Ball—shake him, wait a few moments, then shake again and see whether or not you get a different response. On the side of the Republican leadership’s veteran wing, however, this failure of party brass to respond to the needs of past voters and potential future voters is an ongoing concern somewhat mirrored in the battle for the soul of the Democratic Party between moderates and liberal progressives. The main difference, of course, is that, on the left, progressives seek to take centrist Dems to task for overvaluing corporate interests and not going far enough in seeking policy-based reforms, while Trumpist populists seem more concerned with the right’s refusal to embrace cultural elements of far-right conservatism. Germane to the Republican Party or not, it strikes the observer that Mitch McConnell and other GOP members of Congress greatly overestimated their ability to corral, handle, wrangle, or otherwise work with Donald Trump, much as they overconfidently thought they could ram the Graham-Cassidy Bill down our throats, underestimating we, the people, in the process. Thus, if you believe I believe that the likes of Paul Ryan and Mitch McConnell deserve a shred of sympathy for making a deal with the Devil, you would be sorely mistaken.

There’s no working with Donald Trump because he is a capricious, spoiled, man-baby with no room for other people’s considerations aside from his ego. Moreover, he is a known con man and liar who has exhibited a willingness to step on and over anyone who is an impediment to his desires, and for those who think that he will fulfill their own desires, they would be advised to wait for the other shoe to drop. Or, as Matthew Gertz might put it, wait to be humiliated.