WASHINGTON – House Speaker Paul D. Ryan (R-Wis.) says Obamacare is in a “death spiral,” and he should know: He’s the one who cut the power to Obamacare’s engines and pointed its nose downward.
President Donald Trump says, “Obamacare is imploding and will only get worse,” and he should know: He’s the one who placed the explosives under Obamacare’s foundation.
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), co-author of the GOP health-care bill, says of Obamacare: “We’ve arrived at the scene of a pretty big wreck.” And he, too, should know: He’s the one who dumped oil and tire spikes on the road.
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This is some prodigious cynicism, even by Washington standards. In the past couple of months, the Trump administration and the new GOP Congress have done all they could to undermine Obamacare, and now that their efforts are beginning to succeed they’re claiming Obamacare is collapsing under its own weight.
The Affordable Care Act may or may not be in the death spiral Republicans have long craved, but it has definitely deteriorated since the Trump administration and the new GOP Congress assumed power. And no wonder: They sabotaged it.
They withdrew TV and online advertising encouraging people to sign up for coverage during the crucial period before the deadline. The White House issued an executive order and took other actions that strongly implied it would no longer enforce the “individual mandate” requiring people to sign up for coverage. And the constant promises of imminent repeal have spooked both insurers and individuals from participating.
Trump and congressional allies have, in short, created a self-fulfilling expectation of collapse. “What’s happened since the Trump administration took power is tremendous uncertainty about the future of the ACA,” said Larry Levitt of the Kaiser Family Foundation, which conducts health-care research but takes no position on the law. “For people who were on the fence about participating, the future uncertainty pushes them over. Many insurers, meanwhile, were willing to suffer short-term losses with the promise of future profits, but if the ACA’s future is uncertain there’s little reason to stick around.”
Now opponents of the law are using the wreckage they created to justify their own plan, which the nonpartisan Congressional Budget Office projects would cause 24 million more people to go without coverage than would have under Obamacare. It would dramatically cut coverage for poor and middle-class Americans, increase costs sharply for older Americans and give hundreds of billions in tax breaks to the wealthy and corporate interests. There would actually be more people without health insurance under the GOP plan than there were before Obamacare.
Confronted with the task of selling this cruel plan to the public, the administration and its allies are doing what they’ve done before: attempting to deny reality. They’re seeking to discredit the CBO, perhaps hoping people won’t recall that Republicans picked the man who runs it: Keith Hall, a conservative former George W. Bush administration economist .
Worse, they’re perpetuating the canard that Obamacare was collapsing on its own, leaving them no choice but to repeal it. Walden argued that “if we don’t intercede now, fewer will have access to insurance – period.” Ryan said the “law is collapsing” and asked: “Are we going to stay with Obamacare and ride out the status quo?” And Trump floated a fallback plan: pass nothing, let Obamacare fail and blame Democrats for it.
But they aren’t “letting” Obamacare fail; they’re causing it. As I wrote six months ago, Obamacare extended coverage to more than 20 million, and it works well for most. Slightly more than 2 million people, mostly in rural areas, don’t have competitive plans to choose from and are seeing huge premium increases. Congress could have fixed that by giving insurers incentives to participate in those markets. Instead, Republican lawmakers refused to help insurers and then crowed when insurers complained.
Despite Ryan’s claim of a “death spiral,” the CBO said in its report Monday that the exchanges would remain “stable in most areas” if the current law were left intact, because subsidies and the individual mandate would sustain demand.
The problem is that the administration has been working aggressively to suppress demand, by suggesting the mandate to buy insurance won’t be enforced and by ending government attempts to enroll people. A Brookings Institution analysis said a decline in enrollment for 2017 likely wasn’t caused by premium increases. Joshua Peck, former chief marketing officer for HealthCare.gov, estimated in a post on Medium that Trump deterred 480,000 people from signing up.
Obamacare isn’t failing; it’s being destroyed. And those committing the sabotage ought to own whatever happens next, whether they pass a replacement or not.
Follow Dana Milbank on Twitter @Milbank.