Trump and Obamacare: What’s in a brand name
To relegate Obamacare to the history books is one of President Trump’s most fervent and frustrated desires. But what if Trump, like Oz’s Dorothy, had the power to fulfill his wish all along? As it happens, much of what ails his predecessor’s signature legislation, and the foundering effort to do away with it, could be cured with the president’s trademark skill: branding.
Trump probably owes much of his indeterminate fortune to the dark arts of branding, having affixed his name to everything from real estate and television to water and meat. Meanwhile, he and other Republicans have worked tirelessly to give the Affordable Care Act a bad name — namely, Obamacare — attributing Americans’ every frustration with their rickety health care system to the law, whether it has anything to do with it or not.
This antibranding traps Trump and Republican lawmakers in the Oz-like logic of “repeal and replace,” a phrase repeated so often as to obscure its essential nonsense. Laws repealed — say, Prohibition or the Chinese Exclusion Act — are by definition not replaced. But the demonization of the Affordable Care Act necessitates doublespeak: An allegedly monstrous law must be eliminated, not edited, so even moderate Republicans can’t acknowledge that the ACA needs revision more than repeal.
The unfortunate legislative results have sought to split the difference between conservative Republicans who are ideologically committed to repeal, along with its devastating consequences for health coverage, and moderates who sense that the utility, humanity and growing popularity of the ACA make that impossible. Hence the stalled Senate bill up for reconsideration this week, which would manage to retain much of Obamacare’s structure but undo its chief accomplishments.
Trump has put himself in the same bind as moderate Senate Republicans: He lacks the political capital or ideological commitment to weather the consequences of revoking tens of millions of Americans’ medical coverage, but he has portrayed Obamacare as an intolerable latter-day Stamp Act. A new brand would allow him to acknowledge, along with a much broader and potentially effective coalition of Democrats and moderate Republicans, that
the ACA needs adaptation, not annihilation. To address Obamacare’s real and pretended shortcomings simultaneously, tweaks and tinkers that make it work better could even be effected under another name — say, DonaldCare, JaredCare or MakeAmericaCareAgain.
That would also begin to fix the law’s substantive problems, which can’t be entirely separated from its political and public-relations problems. Take the 19 Republican-led states that refused the law’s federally subsidized expansion of Medicaid, which in most states accounted for the bulk of the reductions in the ranks of the uninsured.
Covering more families under Medicaid would in turn ease pressure on the law’s individual insurance marketplaces, some of which have struggled with dwindling competition among insurance plans and rising premiums. Ending the Trump-led rhetorical war on Obamacare would also reassure nervous insurers wondering whether subsidized insurance exchanges are on their way out, and it would encourage more young, healthy, uninsured Americans to enroll in and shore up the system.
The Republicans’ doomsaying has been self-fulfilling in other ways. Trump’s sometime rival Sen. Marco Rubio, R-Fla., has for example boasted about weakening the exchanges by attacking a provision that protected participating insurers with high losses at the expense of those with high profits.
As evidenced by continuing assaults from both right (repeal) and left (single payer), the Affordable Care Act is an essentially centrist and pragmatist project. It takes the U.S. health care system on its own deeply flawed and convoluted terms and makes it less glaringly bad. Trump, who has made a career of putting his name on things regardless of whether he had much to do with them, should be so lucky as to add Obamacare to his brand.