Trump sets fire to the Affordable Care Act

Donald Trump and fellow Republicans spent much of the Obama administration complaining about how the president was legislating by the fiat of executive order, bypassing Congress and undermining existing law.

So what has President Trump done with his latest actions on the Affordable Care Act? Legislate by fiat, bypass Congress and undermine existing law.

Trump’s actions are a blatant effort to do himself what Congress refused to do this summer: sabotage the health insurance markets that millions of individual Americans have come to rely on to cover themselves and their families.

Here’s the sequence: In 2010 Congress passed, and President Obama signed, a law expanding insurance to at least 20 million people. In the first nine months of this year, Congress considered, and rejected, multiple plans for repealing that law.

Then, in a fit of pique last week, Trump signed an executive order that would allow insurers to sell short-term plans that don’t meet ACA guidelines, and he stopped federal payments to insurers that are used to support private health care markets.

These moves have the potential to upset the delicate balance of the Affordable Care Act, which provides private insurers incentives to offer coverage in individ- ual markets while also giving individuals the right to buy such coverage.

Trump’s executive order, which allows insurers to market skimpy policies, is apparently addressed at Americans who feel that their policies cover too much. It is also a deceptive way of undermining the requirement under the law that all Americans have coverage.

Killing the subsidies that help insurers cover low-income and high-cost patients will raise premiums and result in fewer people being insured. Without those subsidies, and with an ongoing prohibition against denying people coverage based on previous medical conditions, some insurers will simply stop offering coverage to individuals through the ACA.

The non-partisan Congressional Budget Office estimates that ending the payments will raise premiums on popular “silver” health plans by 20% next year and increase federal deficits by $194 billion over the next decade.

Trump’s spiteful actions are full of pettiness and partisanship. If his goal is to force congressional Democrats to the bargaining table on health care, he is playing a dangerous game with people’s lives, akin to committing arson and hoping the fire department shows up.

Legal challenges by health care organizations, governors and perhaps insurers are all but certain. And given Trump’s usurpation of Congress’ constitutional powers, the challengers’ chances of success would appear to be good at first blush, at least regarding the changes to the health care system contained in the executive order.

In the meantime, Congress needs to make clear that it will not allow its institutional rights to be trampled.

The Republican Party, for its part, might want to think long and hard about the future that awaits it as Trump’s reckless actions become more frequent and destructive.