Obamacare is back! And it still has a target on its back.
You might have thought the Affordable Care Act—passed by Congress nine years ago—had finally melded into the broader health care system. But President Trump has pulled out his rusty axe for another assault on the law, which has survived multiple Republican efforts to kill it.
The Trump administration this week changed its position on an ACA court case, joining attorneys general of 20 Republican states in a lawsuit seeking to overturn the entire ACA. The legalities are complicated, but the states have won one court case arguing that the entire ACA is invalid because last year Congress killed the penalty for people who don’t get insurance. The Texas judge who ruled in favor of the plaintiffs is a notorious critic of the ACA, and many legal experts think an appeals court will overturn his ruling, leaving the ACA standing. But the case could get to the Supreme Court, which is more conservative than it was when it upheld the ACA in 2012.
The ACA is deservedly controversial, because it did expose some middle-class families to higher insurance costs. But the ACA has also helped provide coverage to around 20 million Americans who wouldn’t otherwise have coverage. And it ended odious practices such as coverage exclusions for pre-existing conditions, a move Americans overwhelmingly favor. Americans are grudgingly accepting the ACA, with the latest poll showing 50% approve while 39% disapprove.
If Trump gets his way, the death of the ACA would endanger the health care of millions and disrupt an industry that accounts for one-sixth of the U.S. economy. For those reasons, this week’s Trump-o-meter reads FAILING, our second-lowest grade:
Is Trump addicted to chaos? In a week when he could be basking in the political win provided by the apparently underwhelming Mueller report, he is instead picking needless fights that could backfire badly for his party. Republicans tried and failed to kill the ACA in 2017, when they controlled both houses of Congress. Even then, they lacked a credible backup plan and faced political peril if they went ahead with their threats, and threw millions off insurance. Trump insists the GOP will come up with a new and better plan if the courts actually kill the ACA. But the GOP is an empty vessel on health care, and what is more likely to happen is brutal voter payback for a party that looks like it only wants to blow things up.
The Trump legal pleadings in the ACA case may not have any impact on the outcome. So why bother at all? Trump seems to think he’s keeping fealty with his core voters by opposing anything with Democratic provenance. He must not have noticed that health care is gaining steam as a top voter concern, even among some Republicans. Repeal and replace is over. Trump is clinging to a moribund Republican dogma.
Case in point: A federal judge this week struck down a Trump plan to circumvent the ACA and let people buy stripped-down health insurance that doesn’t meet legal requirements. Republicans could have proposed common-sense legislation to amend the ACA so some consumers could find cheaper coverage options, but they didn’t. Since the ACA went into effect, the GOP health care response has been all-or-nothing nihilism, with no coherent effort to actually help health care consumers. Trump is still at it.
Rick Newman is the author of four books, including “Rebounders: How Winners Pivot from Setback to Success.” Follow him on Twitter: @rickjnewman