As Senate Republicans move toward what majority leader Mitch McConnell still insists will be a pre-July 4 recess vote on a bill to repeal and replace the Affordable Care Act, they’re getting an assist -- whether they like it or not -- from the White House.
While President Trump, both before and after his election, has never been shy about attacking the ACA, the administration appears to be stepping up its criticism of the law to a degree that is exceptionally uncommon. On Tuesday afternoon, for example, the White House website launched a new section dedicated to the claim that the system set up under the ACA is “failing.”
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With headlines like “Obamacare Is Failing the American People” and “Nearly 30 Million Americans Still Without Health-Insurance Coverage,” the site reads like the sort of thing usually published by outside pressure groups, not by the administration that is charged with faithfully executing the law.
However, in both cases, those presidents continued to obey and enforce those laws. The Obama administration, for example, did not provide spousal benefits to the partners of homosexual government employees until the Supreme Court clarified the status of gay marriage.
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“I can’t think of an example,” said Aviva Aaron-Dine, a senior fellow and senior counselor at the Center on Budget and Policy Priorities, when asked if she could name another instance in which an administration actively worked to reduce public faith in its ability to execute the law.
“I think the closest analogy might be if you think about Medicare Part D, where many Democrats were initially opposed,” she said. “But people pretty quickly pivoted to working together to making it work well.”
Aaron-Dine, a former senior staff member with the Obama administration’s Department of Health and Human Services who was partially responsible for the ACA’s implementation, said the White House website was particularly frustrating because, “Even taken on its own terms, the website is full of errors.”
For example, she pointed out, it features a map indicating that huge swathes of Iowa and Missouri will be without insurers offering coverage through the law’s health insurance exchanges next year, even though several insurance companies have recently announced plans to begin serving most of those states.
The Trump administration seems to be actively undermining the Affordable Care Act not just politically -- but on the ground. The administration has kept insurers in limbo regarding the payment of subsidies that the law created to support low-income consumers. Even as insurers are trying to decide whether they should continue to offer coverage through the federal exchanges created by the ACA, the administration is advertising its disdain for them and predicting their ultimate collapse.
As numerous experts have pointed out, the administration’s insistence that the system is collapsing is a self-fulfilling prophecy, because a good-faith effort by the administration to make the ACA work is essential to it not collapsing. If insurers sense that the administration is not committed to the law, they will be less willing to participate in the exchanges.
It’s a risky strategy, to say the least. There is real doubt about whether the Republican-controlled Congress will be able to pass a comprehensive health insurance reform package before the ACA’s next open-enrollment period begins.
If lawmakers fail, the White House will be faced with the need to shore up a system that it has already gone to great lengths to undermine.