Failing to Deliver "Great" Healthcare, Trump Now Just Wants System to "Implode"

Now that Senate Republicans have failed to pass even a "skinny repeal" of the Affordable Care Act, it seems the Trump administration will shift back to its strategy of sabotaging the law which governs the nation's healthcare system. After shaming the lawmakers who voted against the repeal, President Donald Trump ominously tweeted early Friday: "Let ObamaCare implode, then deal. Watch!"

For the past seven years, Republicans have waged a war to dismantle Obamacare, but Trump's accession to president gave it new life. As Thomas B. Edsall writes in the New York Times:

The Trump administration has conducted a sustained war of attrition designed to inflict fatal damage on Obamacare. This war, often operating below the radar, entails the use of a quintessentially conservative strategy, and the cooperation of Congressional Republicans. In a way, it's pretty simple: You cut the budget, impose debilitating regulations, track the subsequent missteps and then attack the program as a failure.

There are three key ways, as Axios and The Hill outlined, in which the president can continue his war to undermine the ACA: stopping payments on cost-sharing subsidies; decreasing or sabotaging enrollment outreach; and weakening or outright ignoring the individual mandate.

The Trump administration has been paying Obamacare's cost-sharing subsidies month-to-month, despite requests from insurers for a long-term commitment. As Axios noted, "If he stops those payments, premiums will skyrocket even more than they already have."

The ACA could also suffer if the administration continues its troubling approach to advertising related to Obamacare. During the last open enrollment period, the administration pulled $5 million in advertising that's supposed to encourage Americans to sign up for health insurance coverage, according to The Hill. It also produced negative ads.

The Daily Beast reported on the disparaging ads earlier this month:

Under Secretary Tom Price's stewardship, HHS has filmed and produced a series of testimonial videos featuring individuals claiming to have been harmed by Obamacare....Each testimonial has the same look, feel, and setting, with the subjects sitting before a gray backdrop and speaking directly to camera about how Obamacare has harmed their lives.

"The Trump administration could also decide to stop enforcing the individual mandate, a move experts warn could cause the insurance markets to collapse," The Hill reported. "The mandate is designed to bring in healthy enrollees to balance out the sick ones. But if healthy people have no incentive to buy insurance, only the sickest will, sending premiums soaring."

The administration has already taken steps to weaken the individual mandate, as Reason reported in February, by making it voluntary for taxpayers to report on their IRS forms whether they maintained health coverage--essentially enabling filers to avoid the penalty fee for not carrying coverage, by allowing them to simply not report it.

Although the chairman of the Senate Health Committee, Sen. Lamar Alexander (R-Tenn.), has promised to hold committee hearings in the coming weeks to discuss options for stabilizing insurance markets, action from Trump could further destabilize the individual health insurance market, which sells insurance plans to those who don't have access to it through an employer or public programs.

"The wildcard is what the president does," Sen. Bill Cassidy (R-La.) admitted to The Hill. "Obviously the president, through executive action, can make things ever more difficult."

As Edsall concludes in his aptly titled "Killing Obamacare Softly" Times op-ed: "Whether the ACA can survive the administration's strategy of death by 1,000 cuts, whether any plan delivering quality healthcare at an affordable price could survive a relentless assault like this, remains an open question."