We now have three Republican senators who oppose a clean repeal of Obamacare, so Mitch McConnell’s spiteful parting shot over the failure of Trumpcare is officially dead too. There will be no Republican health care bill for at least the next two years.
The big question now is what Republicans will do instead. They’ve made it clear that what they want to do is sabotage Obamacare so that it will blow up and they can blame Democrats for its failure. They have two main strategies for undermining Obamacare:
- Refuse to pay the CSR subsidies to insurance companies. This amounts to about $8 billion per year, which is used to reduce deductibles and copays for low-income workers. If it goes away, insurance companies will have to make up for it with big premium increases.
- Refuse to enforce the individual mandate. Donald Trump can’t literally remove the mandate from the books, but he can tell the IRS not to enforce it. If that becomes official policy, lots of young, healthy people will forego insurance, knowing that there’s no penalty to pay. This will destabilize insurance pools, which insurance companies will have to make up for by increasing premiums.
These two things will not kill Obamacare. They will not cause a death spiral. They will not cause a mass exodus from the program. In fact, most people won’t even notice anything has happened, since their premiums are capped at a percentage of their income. As premiums go up, their subsidies will go up too, and they won’t pay any more than before.
However, it will hurt middle-class families who make too much money to qualify for subsidies. They’ll see a 20-25 percent increase in their premiums, and they’ll have to pay the whole tab. And that’s after already swallowing a 25 percent premium increase last year.
Are Republicans willing to do this to their middle-class base? Normally I’d say no. That’s crazy. But these are crazy times, and Trump seems to have no qualms about adopting policies that mostly cause pain for his own supporters. “Let Obamacare fail,” he said today. “I’m not going to own it.”
So Republicans might really do it, and then try to lay the blame on Democrats. I don’t think that will work outside of the Fox News bubble, but maybe that’s enough. Stay tuned.
