Copyright New York Magazine
To make a long, complicated story short and simple, congressional Democrats are making a very big gamble that they can convince Donald Trump to impose an extension of Obamacare premium subsidies on his Obamacare-hating troops in the House and Senate. It seems at least somewhat plausible, since Trump is very focused on his party winning the 2026 midterms and his own pollster says finding a way to avoid a huge Obamacare premium price hike could be the key. And perhaps if that works out, all the pain and political risk associated with the ongoing government shutdown will be worth it, certainly to the upwards of 20 million people who will otherwise experience (on average) a doubling of their out-of-pocket health insurance costs. But amidst all his recent globetrotting and deal-making, the 47th president hasn’t had much of anything to say on this subject, until this rather shocking statement somewhere over the Pacific Ocean, as The Hill reports: “We have to fix health care because ObamaCare is a disaster,” Trump told reporters on Air Force One en route to South Korea. “When you see the increases in ObamaCare, it never worked. It never will work, and we can do something with the Democrats much better than ObamaCare,” he continued. “Less money and better health care. And I think that’s something that could come out of this with the Democrats. We work with the Democrats.” Perhaps he has forgotten that the great lost battle of his first term (other than his effort to stay in office after his 2020 reelection bid was defeated) was his legislation to “repeal and replace” Obamacare, which went down to a dramatic defeat in the U.S. Senate in 2017 when he couldn’t hold his own troops in line. In truth, while “repealing” or at least dismantling Obamacare (partially by revoking the Affordable Care Act’s Medicaid expansion, partially by busting up its insurance purchasing exchanges) was the abiding purpose of the GOP’s failed assaults on the 44th president’s legacy program, the “replace” part of the plan was always vague and shaky. Indeed, after the failure of the GOP plan the non-existence of any Trump blueprint for the health care system became a long-running joke. Yes, Republicans continue to talk about “empowering health care consumers” to “make their own decisions.” But the central thrust of their thinking on the subject is to let insurance companies resume discrimination against poorer and sicker people, and to pare back government assistance to make health care more affordable. Faced with the Obamacare premium subsidy expiration price spike, Republicans have taken to criticizing the entire subsidy system as channeling money to insurers rather than consumers. That’s true, but the subsidies are part of a deal in which insurers agree to cover people a free market would leave to suffer and die. The consumers who would save money in a Republican-style system don’t much need health insurance to begin with–until they do. And lurking beneath the surface of GOP rhetoric is an ancient prejudice against the very idea of insurance as a way of protecting people who don’t take care of themselves from the consequences of their own irresponsibility (and/or unfortunate genes). Indeed, Trump’s Secretary of Health and Human Services Robert F. Kennedy Jr. is championing the idea that Americans need to shape up or shut up when it comes to poor health. Trump even hints at this attitude in his own talk about an Obamacare alternative: “I think it’s a great time for the Republicans and Democrats to get together and make something that will work, and let the insurance companies make money — they’re entitled to that, but not the kind of money that they’re making,” Trump said.
