UPDATE: PLEASE READ MY FOLLOW-UP DIARY AFTER YOU FINISH THIS ONE!
Robert Costa in the Washington Post:
President Trump called my cellphone to say that the health-care bill was dead
President Trump called me on my cellphone on Friday afternoon at 3:31 p.m. At first I thought it was a reader with a complaint since it was a blocked number.
Instead, it was the president calling from the Oval Office. His voice was even, his tone muted. He did not bury the lede.
“Hello, Bob,” Trump began. “So, we just pulled it.”
...The Democrats, he said, were to blame.
...Trump said he would not put the bill on the floor in the coming weeks. Instead, he is willing to wait and watch the current law continue and, in his view, encounter problems. And he believes Democrats will eventually want to work with him on some kind of legislative fix to Obamacare, although he did not say when that would be.
“As you know, I’ve been saying for years that the best thing is to let Obamacare explode and then go make a deal with the Democrats and have one unified deal. And they will come to us, we won’t have to come to them,” he said. “After Obamacare explodes.”
“The beauty,” Trump continued, “is that they own Obamacare. So when it explodes they come to us and we make one beautiful deal for the people.”
My question for the president: Are you really willing to wait to re-engage on health care until the Democrats come and ask for your help?
...“Hey, we could have done this,” he said. “But we couldn’t get one Democrat vote, not one. So that means they own Obamacare and when that explodes, they will come to us wanting to save whatever is left and we’ll make a real deal.”
...“You’re right,” he said. “I’m a team player but I’ve also said the best thing politically is to let Obamacare explode.”
...As he waits for Democrats, I asked, what’s next on health care, if anything, policy-wise?
“Time will tell. Obamacare is in for some rough days. You understand that. It’s in for some rough, rough days,” Trump said.
He added, “I’ll fix it as it explodes.
As I noted this morning, while there are real problems with the actual wording of the ACA itself (some of which are fairly significant)...
Other problems, however, were deliberate sabotage on the part of the Republican Party:
- First, of course, the fact that Congressional Republicans have refused to help fix any of the "original law" bullet points for seven years.
- Obstructing Navigators, confusing the public with nonsense about "death panels", refusing to provide accurate information (or any information at all) to potential enrollees about their options, etc etc.
- Flat-out lying to the public about "How many have PAAAAAID!!!", how many are newly enrolled, how much premiums have actually increased for most enrollees themselves, etc.
- THE RISK CORRIDOR MASSACRE, which helped wipe out over a dozen Co-Op start-ups, kicked 800,000 people off their policies, hurt competition and caused a domino effect of other carriers jacking up rates dramatically in many states
- The recent Trump HealthCare.Gov final week "Ad Kill" stunt, which likely hurt exchange enrollment to the tune of up to half a million people
- On his very first day in office, Trump signed an executive order which basically ordered the HHS Dept. and other departments to do everything possible to weaken or sabotage the implementation of the ACA.
...So, you have a combination of all of the above, tremendous uncertainty and a ticking clock, and an administration which has already openly stated that they intend on sabotaging the law as much as possible.
If you're an insurance carrier CEO or board member, then assuming the individual market isn't a major part of your business...how likely are you to stick around next year regardless of whether the AHCA passes or not?
Again, the ACA, as it stands, is mostly working pretty well for most enrollees in most parts of the country...but there are real problems which need to be addressed.
Trump is stating, point blank, that he has absolutely zero plans on resolving any of those issues.
He's also instructed Tom Price and the HHS Dept. to not only not do anything to resolve them, but to go out of his way to do everything he can to hurt them.
What are some of these possibilities? The list is endless. Over at Politico, Dan Diamond has already written up a good piece:
Enrollment could be dampened even more if the administration decides to do little or no advertising next year.
“If the [Trump] administration decides not to run TV ads in the future, this would be concerning," said University of Minnesota professor Sarah Gollust, who has studied TV ads and enrollment. "Particularly so if state governments follow their lead in also cutting their budgets for marketing and outreach — and if enrollment advocates and non-profits cannot pick up the slack."
Tom Price has already announced plans to cut the 2018 Open Enrollment Period from 3 months to just 7 weeks. This in and of itself isn't necessarily a terrible move...but what about 4 weeks? What about 2 weeks? What if the budget for HealthCare.Gov's operations is slashed...understaffing the support phone lines or underpowering the servers? These are similar to the voter suppression techniques that many Republican-held states have been using for years (allocating fewer voting machines in certain precincts, cutting back on early voting days, shortening election day hourse and so forth).
Some of the damage has already been done, and requires nothing more than irresponsible statements on the part of Trump and/or Price:
Trump’s own musings about simply letting Obamacare “fail” — a concept he first openly raised in January — have sent shock waves through the health care industry. Humana has pulled out of the ACA’s exchanges for next year, and other companies warn that the uncertainty may drive them away — though Trump also has met with insurance executives about transitioning to a post-Obamacare system.
“There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017," Mario Molina, CEO of Molina Healthcare — one of the most successful insurers on the ACA exchanges — said on an investor conference call in February and reiterated to POLITICO last week.
...Some former Obama officials say that the changes, particularly extra verification requirements for people who sign up outside the usual enrollment season, may backfire and actually drive health plan customers away.
Then there's the other doomsday possibilities, like Trump issuing an executive order stopping payment on CSR reimbursement payments to carriers.
I'll be addressing all of this and much more in the near future, of course, including my own suggestions for how the ACA should be changed to repair/improve the situation.
For the moment, however, I'm very tired, it's a beautiful Friday afternoon, and I'm going to go play with my kid for a few hours. I think I've earned it.