Being a good leader means sometimes having to take flak for making unpopular decisions. As President Donald Trump goes about reworking Obamacare “piece by piece,” he’s going to catch plenty of criticism. But in the end, it’ll be members of  the GOP establishment who suffer.
“Obamacare is a broken mess. Piece by piece we will now begin the process of giving America the great healthcare it deserves!” Trump declared via Twitter Friday morning.
Trump began late Thursday the process of dismantling the healthcare law with a declaration that taxpayers will no longer be in the business of bailing out insurance companies via cost sharing reduction payments, which amount to about $7 billion in annual spending to pad insurers’ bottom lines.
“Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments,” the White House said in a statement.
These are the same subsidies House Republicans sued the Obama administration over and won last year. The Obama administration appealed the federal court’s ruling, however, and the GOP establishment seemingly gave up on arguing that the Obama administration usurped Congress’s role in appropriating federal money.
Following that setback for Obamacare repeal, the GOP establishment tried and failed to push legislation that would rework the healthcare law. But Republican lawmakers were unable to come to an agreement on the scope and follow-up for any such effort. A handful of conservatives declared they’d settle for no less than the full repeal promised to voters.  Meanwhile, Republicans in states that accepted Medicaid expansion funds via the healthcare law floundered, worried that a full repeal would mean budget turmoil at home.
The problem remains that almost everyone in Washington who isn’t a member of the Democratic leadership has already conceded that Obamacare’s payments to insurers are unlawful.
“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system. Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people,” White House press secretary Sarah Huckabee Sanders said this week.
It certainly seems Republicans are not going to repeal Obamacare. In fact, the GOP leadership has already pretty much told voters that it wants to move on to other issues. The latest legislative vehicle on offer for repeal, the establishment Graham/Cassidy bill, doesn’t have the support needed to pass on Capitol Hill. And even if it did, Republicans wouldn’t be very likely to rush for passage as only around 20 percent of GOP voters believe the legislation takes the right approach to repealing the healthcare law. Consensus among true conservatives is that Graham/Cassidy would do little more than re-brand Obamacare as a Republican healthcare scheme just as insolvent as the law its supporters claim it would replace.
The bottom line on Trump’s decision this week is that the president is taking on the politically unpopular task dozens of GOP lawmakers have refused to handle despite years of promises to voters. And he’s going to get hit with criticism from all sides. Insurers will attack because they stand to lose major funding. Democrats will say Trump is killing the poor. Republicans in Medicaid expansion states will complain about budget issues.
California Democratic Rep. Adam Schiff lashed out at the president on Twitter Friday morning, declaring: “Latest reason why President Trump is the worst President in modern history: Deliberately undermining people’s health care out of spite.”
That’s expected. But what’s really going to be worth watching is how Republicans in Congress proceed.
House Speaker Paul Ryan praised the president’s move in a statement: “Today’s decision … preserves a monumental affirmation of Congress’s authority and the separation of powers. Obamacare has proven itself to be a fatally flawed law, and the House will continue to work with the Trump administration to provide the American people a better system.”
But here’s the deal. There’s already bipartisan legislation that would remove constitutional concerns about the payments via congressional appropriation. And, despite what they say about ending the subsidies, many Republicans (the same establishment lawmakers who championed the weak Obamacare reforms that have so far failed to excite conservatives promised a repeal) are likely to quietly support the deal in an effort to avoid a standoff with the powerful insurance lobby.
There’s also the problem of the pain cutting off the payments will create on Main Street. The Congressional Budget Office reported in August that ending the subsidies would drive insurance premiums up by about 20 percent for Obamacare plans and kick around 1 million Americans off the plans altogether.
Congress is likely to meet this emergency with approval of a plan to extend the payments. A bipartisan proposal to do just that is currently being considered by leaders of the Senate health Committee. If passed, the proposal would appropriate money for the payments for two years, essentially keeping Obamacare as it currently exists afloat in spite of Trump’s efforts to dismantle the healthcare law “piece by piece.”
What Americans are watching unfold right now is Trump versus The Establishment: Obamacare Edition– and when the dust settles, conservative Republicans will have a clear picture of who in Congress they can truly trust. So far, Sen Rand Paul (R-Ky.) (a stand-out in recent months as the GOP’s strongest voice for the kind of Obamacare repeal voters were promised) looks like the president’s strongest ally in picking the healthcare law apart bit by bit.
Paul repeatedly called for an end to the subsidies as well as a rule change to allow for insurance sales across state lines, which was also achieved by Trump’s executive order this week.
“When you get Rand Paul on your side, it has to be positive, that I can tell you,” President Trump said Thursday as he signed the order. “Boy.”