How Trump Can Damage Obamacare Without Repealing It

March 27th 2017

Thor Benson

Since the efforts of President Donald Trump and House Speaker Paul Ryan (R-Wisc.) to pass the American Health Care Act failed on Friday, many are wondering what lies ahead for the Affordable Care Act, also know as Obamacare.

After Republicans pulled their Obamacare replacement, House Speaker Paul Ryan said the Affordable Care Act will remain "the law of the land until it's replaced." Trump said that Obamacare will "explode" and that a replacement will be demanded by Democrats and others at a later date.

What's next for the Affordable Care Act?

"The indications are that the White House is going to move on for the time being," Gerald Kominski, director of the UCLA Center for Health Policy Research, told ATTN:. He said citizens are still receiving insurance, still getting subsidies, and will still be eligible for enrollment. 

Matthew Fiedler, a fellow with the Center for Health Policy at the Brookings Institute, told ATTN: that Trump's prediction of an Obamacare "explosion" are off base, as well. Obamacare insurance prices appear to be stabilizing at this point, and the market overall looks more stable than it has been in previous years, he said. 

Essentially, barring any unforeseeable events, Obamacare will keep doing what it's doing. The Congressional Budget Office (CBO) estimated earlier in March that Obamacare will still cover over 24 million citizens in 10 years.

However, Trump and his administration could attempt to undermine the law.

"There's a lot of talk that the ACA is imploding on its own, and it's about to go over a cliff," Kominski said. "But the reality is that the law is working for millions of Americans, and the only reason that it would start to implode is if the administration starts to actively take measures to destabilize the marketplace."

obama signing affordable care act

What can Trump and Sec. Tom Price do to dismantle Obamacare?

Kominski said it looks like Health and Human Services Secretary Tom Price and Trump may intentionally damage how effective the Affordable Care Act can be to push Democrats and citizens toward wanting a replacement. He said it appears Trump and Republicans will try to force Democrats to negotiate with them using a "hostage taking strategy," which would involve making Obamacare less effective and less popular.

Fiedler said one thing Price and Trump could attempt to do is to stop enforcing the individual mandate, which is the part of Obamacare that imposes a penalty upon those who refuse to purchase a health insurance plan. The individual mandate keeps insurance costs down because it forces healthy people to buy into the healthcare system, which they may not do otherwise. So, Price and Trump could make Obamacare unfeasible and more unpopular by taking away the penalties imposed on those who don't buy healthcare, which would drive up premiums for everyone else. 

The Trump administration has actually already undermined the individual mandate. It did so by changing tax filing rules so that the IRS now doesn't require citizens to indicate if they had health insurance the previous year, which makes it very difficult to tell if they met the individual mandate requirement.

tom price

What parts of Obamacare can't be changed without a replacement?

Kominski said there are certain things in Obamacare that can't be changed unless the entire bill is repealed, like how Obamacare prevents insurance companies from charging more when someone has a pre-existing condition.

Medicaid expansion is probably safe, as well. "If they tried to cut off Medicaid funds, a state would sue, and it would successfully continue its Medicaid expansion," Fiedler said.

trump executive order

How does Trump's executive order from January affect Obamacare?

Shortly after taking office in January, Trump signed an executive order that was meant to roll back Obamacare while a replacement was determined. The executive order essentially called on Price to lessen the "economic burden" Obamacare puts on citizens, health care providers, and insurance companies. It instructs the agency to more loosely interpret regulations in the law so insurance companies and health care providers can save money. 

"An executive order is ultimately just instructions to agencies to consider actions, so I think it really will depend on what the agencies do in response to that executive order," Fiedler said. If the HHS makes decisions based on that executive order that weaken the individual mandate, for example, then the effect could be significant. On its own, Fiedler said, the executive order doesn't do much.

bernie sanders

Will Trump work with Democrats to pass a new law?

Trump's chief of staff, Reince Priebus, said on Fox News on Sunday that the Trump administration is willing to work with Democrats to achieve health care reform. However, it's hard to tell if they will actually commit to this.

Fiedler said Democrats are simply interested in making Obamacare work better, while Republicans and Trump want more drastic changes, so it'd be pretty hard for them to find a compromise. 

Kominski said Trump's legacy could benefit from working with the Democrats to accomplish real health care reforms, but it's unclear if he's willing to do so. He said compromising with Democrats has not appeared to be the goal of those surrounding Trump and advising him. 

"At some point Trump has to decide what kind of president he wants to be," Kominski said.