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OPINION

Who’s to blame if the ACA blows up?

By DOYLE MCMANUS | Los Angeles Times | Published: October 19, 2017

President Donald Trump still doesn’t get it: He owns “Obamacare” now.

He’s been hard at work undermining the government-regulated health insurance program — eliminating subsidies to insurance companies, slashing programs to enroll new customers, authorizing bare-bones plans to lure healthy patients out of the insurance pool. But if the system collapses, he insists it won’t be his responsibility. “I think the Democrats will be blamed for the mess,” he said on Monday.

Trump’s argument is twofold: Obamacare wasn’t his doing, and the program is already “finished. It’s dead. It’s gone,” as the president put it on Monday. “There is no such thing as Obamacare anymore.”

So if customers see their premiums rise or their plans disappear, how can that be his problem?

“When the premiums go up, that has nothing to do with anything other than the fact that we had poor health care — delivered poorly, written poorly, approved by the Democrats,” he said.

It’s absurd to say Obamacare is “dead.” Insurance under the Affordable Care Act exchanges still covers about 11 million Americans, and thousands more are expected to sign up this fall. (That’s not counting Medicaid expansion.)

It’s also absurd for Trump to believe he won’t be blamed. Most Americans want their president to manage government programs, reform them or shrink them — not blow them up. Indeed, a Kaiser Family Foundation poll this month found that 71 percent of Americans think the government should try to make the law work; only 21 percent thought the government should try to make the law fail. Among Republicans, 48 percent favored supporting the law; only 43 percent favored undermining it.

Those lopsided numbers may help explain why, last week, Trump abruptly canceled subsidies that help insurance companies cover millions of low-income people — only to then claim he wants Congress to restore the payments.

If Trump had framed the cancellation as a constitutional issue, that apparent 180-degree turn would make sense. Republicans have long argued that the subsidies aren’t legal without a formal congressional appropriation.

But that’s not what Trump did. He objected to the payments as a matter of what sounded like high principle. “That was a subsidy to the insurance companies. That was a gift,” he said. “You could almost call it a payoff. And it’s a disgrace.”

Now, the White House says Trump will go along with a bipartisan Senate deal that would restore the subsidies for two years, as long as he gets something in return. His move was a bargaining ploy, in other words. Even so, there’s no guarantee that the deal can get through the conservative-dominated House of Representatives.

An impasse would put the president in a precarious position. Canceling the subsidies means Obamacare premiums will go up all over the country by an average of 19 percent, according to one Kaiser Foundation expert. Trump won’t be able to pin that one on the Democrats.

Trump wants to have it both ways. He wants Obamacare to die, but he doesn’t want his fingerprints on the corpse.

Too late. He’s already bragged too loudly, and too often, that he plans to stand by and watch the program collapse. Worse, he’s still promising voters that he’s about to deliver much better health insurance at a much lower cost. That’s a promise he has no strategy to fulfill.

“Since Congress can’t get its act together on health care, I will be using the power of the pen to give great health care to many people — FAST,” the president tweeted last week.

“People will have great, great health care,” he added. “And when I say people, I mean by the millions and millions.”

The executive orders he signed last week won’t do all that. If they stand, they will loosen regulations to allow stripped-down insurance plans that don’t offer all the benefits guaranteed by Obamacare. They’ll be cheaper. They won’t all be better. For anyone with an existing medical condition, they’ll be worse. And they’re unlikely to cover millions of people fast.

Whether Trump understands it or not, he’s rhetorically embraced the principle that the federal government is responsible for ensuring good, affordable health care for every American. In fact, not just good health care; “great” health care. That’s something no previous Republican president has done.

As Barack Obama discovered to his chagrin, when a president takes responsibility for health insurance, he often gets blamed for anything that goes wrong — including, in Obama’s case, cost increases for people who get insurance through their employers.

Sooner or later, voters are going to take the president at his word and hold him to his promise of better health care at lower cost.

Sometime, say, around next year’s enrollment season for insurance plans — which happens to come at the same time as the 2018 congressional election.

Doyle McManus is a Los Angeles Times columnist.

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