There is still the ACA and while reports of its inevitable impending explosion and collapse are complete hoohah it is an entity that needs the executive branch to minimally do their part in executing it, and which ideally would still have some improvements to it.
Will the Trump administration take active steps to make it do poorly (the pulling of enrollment ads right away was widely seen as that)?
Or just neglect to do any of its routine care and maintenance? Ignore its leaks?
Or will Congressional Democrats push forward some fixes (not repeal/replace … repair) and hope to get enough of the GOP to peel off to support it, which Trump could veto but then own the problems? As a minority party can they?
Relatedly, large amounts of GOP animus to the VA system was that it was a model of government care and demonizing its problems was vital. They had wanted it privatized and Trump’s unanimously approved VA head, Shulkin, is clear he is not going that way. Will a GOP Congress give him reign to make it work as a non-privatized system?
Oh, I think it’s a foregone conclusion that TrumpCo will work hard to undermine the ACA and do their best to create their designated outcome of imploding and exploding (like a dying star, I guess).
They’ll do nothing to rein in costs or profits.
To the extent they can chip away at protections built into the Act on a case-by-case basis, they’ll do that.
Democrats must point out every single time this happens. They’ve done a less than impressive job to date. Instead of saying that Obamacare is flawed, they would be far more productive to point out what a success it has been despite the tremendous efforts to undermine it by conservatives: Fighting tooth and nail to eliminate the public option component of the legislation; twenty-six states that rejected Medicaid expansion solely to shore up their political ideology, even at the expense of the well being of their citizens; Marco Rubio’s sneaky elimination of the risk corridor protections in the Act; voting 66 times (or was it 67?) to repeal, instead of working in a sanguine manner with Democrats to improve the ACA, and so forth.
Democrats also need to craft and present many bills that improve the ACA and force Republicans to publicly reject these common-sense fixes. Bernie Sanders has introduced such legislation already and much more should follow. At least show Americans they have an actual choice, depending on for whom they vote into Congress. They should never let up their constant pressure to offer real alternatives.
Obama said from the outset that the ACA was flawed due to the elimination of the public option and that he would accept half a loaf as the best he could get at the time. He never had any illusions that the task of overhauling the complicated American health care system was complete. I expect Republicans to exploit its flaws to the fullest.
If Trump has any sense he’ll maintain Obamacare to the letter, pissing off the Republicans by saying “I** tried to replace it, you said No; now fuck off and die.**”
They need him more than he needs them. For one he is charismatic whilst they have the charisma of a barrel of month-old herring; whilst if they go against him, and ludicrously impeach him in favour of Gnome Pence, they will be punished for their disloyalty as few parties ever have by the common voters.
Many bought Obama’s Hope & Change thing, at least for a few months after, similar to Trump’s braggadocio for public consumption, had the Democrats tried to replace Obama — maybe for basic uselessness — they would have been punished in the same way.
I don’t participate much in political threads, so my observation here might not be revelatory. I think Obama’s move to push the ACA, getting it passed despite its flaws, was ingenious. He may have even known that there was a good chance it wasn’t sustainable in its current form, but simply creating its existence put up a huge barrier for opponents of universal healthcare. It was an experiment, and since there was no shot at a single-payer system getting approved, the best he could do. However, once enough people start receiving a benefit, it’s very difficult to take it away. He knew this. Right wing Republicans might yell and scream that it’s unconstitutional or anti-American, but so many people within their constituencies are receiving those benefits. Taking it way completely would be too risky of a move, and I think many probably secretly want for it to stay in place. However, they still have to pander to their right-wing bases, so they have to publicly show that they hate it on principle. At this point, Congress only has 2 options: improve it or eliminate it. And the latter could be political suicide. Just like Obama drew it up!
Almost predictable:
*President Donald Trump on Sunday attacked conservative lawmakers for the failure of the Republican bill to replace former President Barack Obama’s health care law, as aides signaled a greater willingness to work with moderate Democrats on upcoming legislative battles from the budget and tax cuts to health care.
On Twitter, Trump complained: “Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood & Ocare!”* Yahoo NewsBlaming conservatives, Trump signals new openness to Dems
If House Democrats have any sense they will seize this opportunity to pull Trump away from his Republican allies, and enable him to be a president for all, doing their purposes well as the right wing’s.
And the week after, Trump throws the Dems under the bus and goes looking for new victims. Or looks to see if the GOP wants another turn in the barrel.
Whatever suits him at the moment.
OTOH responding something like this?
*
We Democrats will of course be willing to work together with Republicans … in fact here are some specific things that we think can work on - helping make the ACA better inclusive of further expanding Medicare and fully supporting its implementation, improving infrastructure, reducing student debt, immigration reform, meaningful action on global warming (not to make it worse doofus), seriously addressing wealth inequality and the declining position of America’s working class, moderate SC nominees that we can mostly all agree on …
These are things we can work together on that will make this great country even greater. We reach out to our GOP counterparts to work together on them.
Things that we believe make us smaller and that harm us all we will fight with all we have.
I’m pretty skeptical Trump will really get very far with a strategy to undermine the ACA from within. Reasons:
If the last 8 years have demonstrated nothing else, its that the public tends to blame the Prez for problems, whatever the evidence is. And in this case, Trump’s party would have control of all levels of gov’t. The risks of a failing healthcare market getting blamed on the GOP seem better than even.
It’d be hard to do. Most of the HHS bureaucracy wants the ACA to succeed. Which means it’d take a lot of arm-twisting and a fair amount of patience (which Trump doesn’t have) to undermine the ACA, and every step in the process would get leaked to the press.
Blue states (and States like Kentucky) that are interested in universal coverage can more or less do most of the work themselves, as long as the checks from the Fed clears. So you’d end up with failing markets in red states, and increasing coverage and availability in blue ones. This make the argument that any failure is due to the law itself rather than Trump’s execution of it hard to make.
As with the recent repeal bill, the cost of undermining the ACA will fall most heavily on GOP constituents. There’s obviously a block of the GOP that’s OK with this, but as with the ACHA bill debate, I think the block that isn’t is large enough to fracture the party.