How to Save Obamacare From Trump

This past weekend, liberals across the country celebrated the demise of the American Health Care Act as a triumph of Obamacare over the reactionary forces determined to tear it down, and rightly so. The Republican Party’s failure to repeal the Affordable Care Act outright is not just a huge relief to those who believe in the principle of a health care guarantee for all Americans; it’s a godsend to those who have benefitted from the health insurance expansion facilitated by President Barack Obama’s signature legislative accomplishment.

But ACA supporters shouldn’t become complacent simply because a Republican health care bill is not going to become law anytime soon. The Republican opposition to Obamacare is about to become more dishonorable than at any point since Obama signed it seven years ago.

Republican leaders, including President Trump and House Speaker Paul Ryan, have done almost nothing to disguise their intent to mismanage the Affordable Care Act into failure.

“I think we are doing the architects of Obama a favor by passing this law [sic] before it gets even worse,” Ryan said at a Friday Capitol briefing after pulling the GOP bill. “Well, I guess that favor’s not going to be given to them and it’s gonna get worse. And so, I don’t think the architects of Obamacare—I’m sure they may be pleased right now. But when they see how bad this thing gets, they said all the projections were being told by—by the plans that are participating in Obamacare, I don’t think they’re gonna like that either.”

Trump told The New York Times that “Obamacare unfortunately will explode [and] Democrats will come to us and say, ‘Look, let’s get together and get a great health care bill or plan that’s really great for the rest of the country.”

The generous interpretation of these pronouncements is that Republicans believe a significant segment of the U.S. health care system is failing, and are boasting about their intent to do nothing about it in the hope that the ensuing suffering will revive the Obamacare repeal process. As the Huffington Post writer Jeffrey Young noted, “Believing the health care system will collapse and spitefully refusing to do anything about it is reprehensible.”

But as Young notes, the “premise that the Affordable Care Act is irreparable” is “highly debatable,” and the odds that Ryan, Trump, and others haven’t been briefed on the many analyses indicating that the law is basically stable hover near zero. The more credible interpretation is that Republicans are taking, and will continue to take, affirmative steps to harm the law in order to manufacture its collapse. They believe Obamacare is so closely identified with Democrats in the public imagination that Democrats will bear the political consequences of reckless GOP subterfuge—and that this sequence of events will bring Trumpcare back from the dead.

It is within the GOP’s power to sabotage Obamacare if its leaders are so determined. But they can not count on sheer will to deliver parts two and three of the plan. They can only succeed if congressional Democrats, liberal activists, and the media all fail.

It is incumbent upon not just supporters of the law, but anyone in the business of representing facts to the public, to be clear about the following: the Obamacare status quo that Trump inherited; the actions Trump and his GOP allies are taking now; and the extent to which ensuing problems with the ACA are consequences of those actions.

Democrats in Congress have an added obligation not just to decry the GOP’s mischief or malign neglect, but to loudly propose legislation that would address some of Obamacare’s real problems. This can include proposed improvements to the ACA itself (like a public insurance option, higher subsidies, or more technical market stabilization tools), or more comprehensive plans, like the one Senator Bernie Sanders supports, to replace the ACA with Medicare for all. To the extent that GOP mismanagement has a material effect on premiums and competition, it will be essential for Democrats to point to solutions Republicans are intentionally shunning, not just attack them for abdicating their obligation to faithfully execute the law.

It would be a failure to quietly allow the GOP’s tendentious predictions of an Obamacare collapse to become a self-fulfilling prophecy.

Consider the long-forgotten fact that one of Trump’s first official actions was to sign an executive order directing federal agencies to “ease the burdens of Obamacare.” The intent of that order was always underhanded, but until the AHCA failed, its nominal purpose was to begin the transition away from Obamacare toward a different system Republicans would enact on their own.

As Democratic Leader Chuck Schumer noted on the Senate floor Monday, the only plausible purpose that order now serves is to destabilize insurance markets. “Now that Trumpcare is off the table, the president should rescind the executive order,” Schumer said. “Today, I am urging the president and his entire administration to immediately cease all efforts to undermine the ACA. People’s lives are at stake.”

It is up to others to see that all of the administrative steps Republicans take, including the order, get aired out in public unspun, free from the pretense that an imaginary Republican Obamacare alternative will ride to the rescue.

This poses greater respective challenges to reporters and activists than the AHCA process, which came equipped bill text, policy analysis, committee votes, and other clear channels of accountability. Scrutinizing the contents of jargon-filled HHS memos, determining the likely impacts, organizing protests around them, making members of Congress answer for what’s happening in the executive branch—all of these tasks are much more complicated than covering (or protesting) legislation.

Defeating Trumpcare was ACA supporters’ most important political victory in years, but it didn’t vanquish the Obamacare opposition once and for all. The final fight will be much harder, and it has only just begun.