The battle is not done

Richard Fulton

A little over a week ago the headline on the front page of USA Today read: “USA split on Trump impeachment.” I do not want to comment at this point on whether or not he should be impeached.

I just think we should contemplate how utterly shocking it is to think that a president in office for only seven months can conjure a response so drastic.

What I do want to write about is, given the fact of the failure of the so called “skinny“ repeal and replace” Republican bill last week, have we now come to the end of the line for Republican obstructionism? The answer is, hardly.

The president has said, amongst other options he has supported, that he prefers to let the Affordable Care Act die of its own weight. The problem is that it is not dying, it has provided health care for tens of millions for over seven years without collapsing.

This is not to say that serious problems persist and need attention. Instead of addressing these, Trump has turned to some options that he might use to undermine the ACA and make it less tenable.

First among these options is to weaken the enforcement of the law’s individual mandates: one of the “skinny” bill’s targets. This mandate says that all must have health insurance or pay a tax penalty. The Trump administration can do a variety of things to undermine this vital source of income that underpins the ACA.

He can instruct the IRS to be lax in the enforcement of this mandate. The IRS can continue to take tax returns that do not note the presence of health insurance. He can instruct the IRS to grant more exceptions to the law. Much of this borders on malfeasance, but it is difficult to counter.

The administration can, secondly, fail to continue the promotions of the program that educate people on their options. This would lessen the number of Americans sufficiently informed to apply for programs within the law they are eligible for that help them pay for the insurance.

He and the Republican congress can defund the insurance company subsidies that help individuals pay out-of-pocket costs. This is complicated, but at base it is a foundation income for health insurance companies without which they leave crucial markets.

The insurers already have held back participation because of the insecurity of policies promoted by President Trump. His vacillation between options and his statements of non-support at one minute, but support the next, leave insurance companies wary of proceeding. They want to participate if there is stability.

The administration could tinker with tax credits that help the middle class afford decent coverage.

States vary in their participation in Medicaid. The more conservative ones, like Missouri, did not take the federal government’s monies to expand Medicaid and now want to find ways to lessen their increasing liabilities for poorer citizens.

Some of these states want to add work requirements, for example. Even though most on Medicaid are elderly, youth, babies, or adults already working.

The point is if President Trump wants to be mean (like his characterization of the House version of repealing the ACA) he might find ways to impede it through his role as head of the executive administration.

No battles in Washington are really won once and for all. As I noted last week, the Republican “Dracula” approach to health care reform means that, Trump, in the dark of back rooms, can revive the seemingly dead, horrible Republican health care replacements by undermining the ACA.

And in the process drain the life’s blood out of those without coverage.

Richard Fulton is an emeritus professor of political science.