President Trump came into office promising some fabulous yet unspecified health-care plan to replace the Affordable Care Act. No plan existed; every plan Republicans came up with managed to reduce the number of insured. Trump promised never to cut entitlements; his fiscal 2020 budget proposal would have done just that.
Trump said he’d bring back manufacturing. In fact, it slowed and now has slumped. (“Manufacturing has slowed amid global uncertainty,” NPR reported earlier this month. “That’s one of the reasons the Federal Reserve gave for cutting interest rates this week.”)
Trump said he’d
- get tough on drug companies. He hasn’t. He said his
- tax cut would be aimed at the middle class,
- deliver $4,000 a year to the average American family and
- permanently boost business investment, pushing growth above 3 percent. Nope, nope and nope.
The worst thing that Attorney General William P. Barr did this week arguably had nothing to do with possible contempt of Congress or the Mueller report.
It had to do with health care.
On Wednesday, amid the circus over alleged special counsel snittiness, the department that Barr oversees formally asked a federal appeals court to strike down the entire Affordable Care Act, jeopardizing access to health care for tens of millions of Americans.
If the Trump administration prevails, everything in the law would be wiped out. And I do mean everything: the protections for people with preexisting conditions, Medicaid expansion, income-based individual-market subsidies, provisions allowing children to remain on their parents’ insurance until age 26, requirements that insurance cover minimum essential benefits such as prescriptions and preventive care, and so on.
The administration’s rationale was laid out in a policy brief supporting a lawsuit challenging Obamacare by 20 red states. Their logic: When Congress, as part of President Trump’s 2017 tax cuts, set the penalty for not carrying health insurance to zero, that effectively made it no longer really a “tax,” and therefore made it unconstitutional. Somehow, that rendered the rest of the law unconstitutional, as well — including lots of provisions having nothing to do with the mandate.
This reasoning has been rejected even by conservative legal scholarsotherwise opposed to the law. But legal merits (and demerits) aside — which are likely to be ultimately adjudicated by the Supreme Court — it’s also not clear what political upside Republicans could possibly see in mounting yet another overt attack on Obamacare.
The GOP’s November congressional losses were largely motivated by voter rage over the party’s attacks on Obamacare, after all. Trump has, of course, more recently proclaimed the GOP the “party of health care,” and he and other party leaders continue repeating the obvious fiction that they’re cooking up “something terrific” to replace the ACA.
About half of the U.S. population has employer-based coverage, including 60 percent of nonelderly adults. While most say they are generally satisfied with these health plans, many nonetheless struggle with the financial burden they impose — particularly the high-deductible plans that cover 4 in 10 people with employer-sponsored insurance.
Deductibles in employer-sponsored insurance have been rising since long before the ACA. They have nearly quadrupled over the past 12 years and now average $1,350 for a single-person plan. But separate survey data show that only half of nonelderly, one-person households report having at least $2,000 in savings available.
A surprise move by the Trump administration aimed at striking down the Affordable Care Act thrust the partisan battle over health care into the middle of the 2020 campaign on Tuesday, handing Democrats a potential political gift on an issue that damaged Republicans badly in last year’s midterm elections.
In a new court filing, the Justice Department argued that the ACA, also known as Obamacare, should be thrown out in its entirety, including provisions protecting millions of Americans with preexisting health conditions and allowing young adults to stay on their parents’ health-care plans.
President Trump praised the move during a lunch with Senate Republicans, and suggested the GOP should embrace a new congressional battle over health-care policy ahead of the 2020 elections.
“Let me tell you exactly what my message is: The Republican Party will soon be known as the party of health care,” he told reporters before the lunch. “You watch.”
.. Trump spent much of his time at the Senate lunch talking about health care, according to several senators present.
“If there’s a message to be learned from 2018 on policy, it’s health care,” Sen. Lindsey O. Graham (R-S.C.) told reporters after the lunch Tuesday. “Let’s become the party of health care.”
“He thinks that that’s the one area where we’ve fallen short and he wants to see us address it,” said Sen. John Neely Kennedy (R-La.). “He made that very clear.”
“If you’re a Republican thinking about 2020 right now, you want to be on offense on health care, not defense,” she said. “And the only way to do that is to make the focus on what Democrats want to do — on Medicare-for-all — rather than making it on what the president and the White House are suggesting.”
.. A federal judge in Texas ruled in December that the law’s individual mandate “can no longer be sustained as an exercise of Congress’s tax power” and further found that the remaining portions of the law are void. He based his judgment on changes to the nation’s tax laws made by congressional Republicans in 2017.
.. “It is highly unusual for the Department of Justice not to defend duly enacted laws, which the Affordable Care Act certainly was,” Collins said. “This decision to even go more broadly in failing to defend the law is very disappointing.”
.. “I think Obamacare should be gone,” he said. “We’ve got to cover people with preexisting conditions apart from Obamacare, which is what I talked about a lot.”
.. There would be ripple effects throughout the health-care industry and insurance landscape as well. Those with workplace plans could be affected, as employers would be allowed to scale back certain medical benefits, and people with preexisting conditions buying coverage on their own would no longer be guaranteed access to coverage at no extra cost.
None of Trump’s extremist policy ideas has received public support. The public opposed last year’s
- Republican-backed corporate tax cut, Trump’s
- effort to repeal the Affordable Care Act (Obamacare), his
- proposed border wall with Mexico, the decision to
- withdraw from the Iran nuclear agreement, and the
- imposition of tariff increases on China, Europe, and others.
- At the same time, contrary to Trump’s relentless promotion of fossil fuels (coal, oil, and gas), the public favors investments in renewable energy and remaining in the Paris climate agreement.
.. Trump has tried to implement his radical agenda using three approaches.
1) The first has been to rely on the Republican majorities in the two houses of Congress to pass legislation in the face of strong popular opposition. That approach succeeded once, with the 2017 corporate tax cut, because big Republican donors insisted on the measure, but it failed with Trump’s attempt to repeal Obamacare, as three Republican senators balked.
.. 2) The second approach has been to use executive orders to circumvent Congress. Here the courts have repeatedly intervened, most recently within days of the election, when a federal district court halted work on the Keystone XL Pipeline, a project strongly opposed by environmentalists, on the grounds that the Trump administration had failed to present a “reasoned explanation” for its actions. Trump repeatedly and dangerously oversteps his authority, and the courts keep pushing back.
.. 3) Trump’s third tactic has been to rally public opinion to his side. Yet, despite his frequent rallies, or perhaps because of them and their incendiary vulgarity, Trump’s disapproval rating has exceeded his approval rating since the earliest days of his administration. His current overall disapproval rating is 54%, versus 40% approval, with strong approval from around 25% of the public. There has been no sustained move in Trump’s direction.
.. In the midterm elections, which Trump himself described as a referendum on his presidency, the Democratic candidates for both the House and Senate vastly outpolled their Republican opponents. In the House races, Democrats received 53,314,159 votes nationally, compared with 48,439,810 for Republicans. In the Senate races, Democrats outpolled Republicans by 47,537,699 votes to 34,280,990.
.. Summing up votes by party for the three recent election cycles (2014, 2016, and 2018), Democratic Senate candidates outpolled Republican candidates by roughly 120 million to 100 million. Nonetheless, the Republicans hold a slight majority in the Senate, where each state is represented by two senators, regardless of the size of its population, because they tend to win their seats in less populous states, whereas Democrats prevail in the major coastal and Midwestern states.
Wyoming, for example, elects two Republican senators to represent its nearly 580,000 residents, while California’s more than 39 million residents elect two Democratic senators.
Without control of the House, however, Trump will no longer be able to enact any unpopular legislation. Only policies with bipartisan support will have a chance of passing both chambers.
.. On the economic front, Trump’s trade policies will become even less popular in the months ahead as the American economy cools from the “sugar high” of the corporate tax cut, as growing uncertainty about global trade policy hamstrings business investment, and as both the budget deficit and interest rates rise. Trump’s phony national-security justifications for raising tariffs will also be challenged politically and perhaps in the courts.
.. True, Trump will be able to continue appointing conservative federal judges and most likely win their confirmation in the Republican-majority Senate. And on issues of war and peace, Trump will operate with terrifyingly little oversight by Congress or the public, an affliction of the US political system since World War II. Trump, like his recent predecessors, will most likely keep America mired in wars in the Middle East and Africa, despite the lack of significant public understanding or support.
.. Nonetheless, there are three further reasons to believe that Trump’s hold on power will weaken significantly in the coming months. First, Special Counsel Robert Mueller may very well document serious malfeasance by Trump, his family members, and/or his close advisers.
.. Second, the House Democrats will begin to investigate Trump’s taxes and personal business dealings, including through congressional subpoenas. There are strong reasons to believe that Trump has committed serious tax evasion (as the New York Times recently outlined) and has illegally enriched his family as president (a lawsuit that the courts have allowed to proceed alleges violations of the emoluments clause of the Constitution). Trump is likely to ignore or fight the subpoenas, setting the stage for a major political crisis.
.. Third, and most important, Trump is not merely an extremist politician. He suffers from what author Ian Hughes has recently called “a disordered mind,” filled with
- paranoia, and
According to two close observers of Trump, the president’s grip on reality “will likely continue to diminish” in the face of growing political obstacles, investigations into his taxes and business dealings, Mueller’s findings, and an energized political opposition. We may already be seeing that in Trump’s erratic and aggressive behavior since the election.
.. The coming months may be especially dangerous for America and the world. As Trump’s political position weakens and the obstacles facing him grow, his mental instability will pose an ever-greater danger. He could explode in rage, fire Mueller, and perhaps try to launch a war or claim emergency powers in order to restore his authority. We have not yet seen Trump in full fury, but may do so soon, as his room for maneuver continues to narrow. In that case, much will depend on the performance of America’s constitutional order.