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The human cost of Trump’s health care tantrum

President Trump. Pablo Martinez Monsivais/Associated Press

Presidents take a solemn vow to execute the responsibilities of their office, and, for the foreseeable future, overseeing Obamacare is part of the job. Donald Trump’s tantrum on Tuesday, when he said his administration would let the law fail after a Senate replacement plan collapsed, marks an astonishing abdication of responsibility. If the president follows through on his implicit threat to intentionally sabotage the health care market, Trump will inflict a needless burden on millions of consumers.

The executive branch — Trump and Secretary of Health and Human Services Tom Price — exerts enormous influence on the insurance market. The administration could, for instance, refuse to enforce the law’s individual mandate, or eliminate some subsidies for low-income Americans. It could refuse to allow advertisements during the sign-up period. Contrary to Trump’s rhetoric, the Affordable Care Act isn’t “imploding” now. But if Trump and Price actively seek to undermine the health law, they could probably induce a crisis on the state insurance exchanges.

Trump seems to believe that if that happens, it would force Democrats to go along with repealing the entirety of Obamacare. As a political strategy, though, there’s a good chance that purposely destablizing the markets would backfire on the GOP. Extremists in the Republican Party tried a similar tactic in the debt ceiling negotiations during the Obama administration, holding the nation’s fiscal health hostage if they didn’t get their way on spending. That strategy didn’t work then, and it’s hard to imagine it succeeding when so many Americans’ insurance coverage is at stake. Consumers would likely blame Trump, and they’d be right.

Regardless, Trump’s willingness even to entertain the possibility shows a cynical, cavalier indifference to the actual human cost of his administration’s actions. The consumers who need to buy policies on the health insurance exchanges are not pawns: they are the public that Trump is supposed to be serving. This president — any president — should be working as hard as possible to meet Americans’ needs with the tools at his disposal.


Unfortunately, Trump’s behavior on Tuesday was hardly surprising. It has become clear during the whole health care debate that Trump barely knows or cares what the Affordable Care Act is, or what the House and Senate replacement plans would do instead. He wants something that he can call a win.


It will fall to the responsible members of Trump’s party — including Susan Collins and the handful of other Republican senators who thwarted the repeal bill, and Charlie Baker and other Republican governors who lobbied against it — to steer the administration away from that destructive path. If Trump thinks he can improve on Obamacare, he needs to do the hard work of building a coalition in Congress. In the meantime, nothing is gained by driving insurers away. When Senator Shelley Moore Capito of West Virginia announced her opposition to the Senate bill, she said: “I did not come to Washington to hurt people.” Did the president?