SOUNDING LIKE a demented hostage-taker, Donald Trump last week publicly toyed with the idea of using millions of American lives as political bargaining chips.
"I don't want people to get hurt," he told the Wall Street Journal, while threatening to do just that. In an attempt to coerce Congressional Democrats to help him dismantle the Affordable Care Act (Obamacare), Trump said he would sabotage the health-care system (on purpose) and possibly crash the insurance markets. This could abruptly end coverage for millions and spike insurance rates.
Here's the situation and it's complicated: There are two kinds of subsidies under the ACA: funding to help individuals pay their premiums and about $7 billion in subsidies paid directly to insurance companies to help lower co-payments and deductibles. These "Cost-Sharing Reductions" — CSRs — cover about 7 million Americans with incomes less than 250 percent of poverty (under $30,150 for an individual).
In 2014, House Republicans challenged the CSRs in court alleging that the ACA legislation did not include proper authorization language while the Obama Administration argued that the subsidies are legal. In an unprecedented decision, a federal judge found in Republicans' favor, but the subsidies continued while the government appealed.
Now, with Obama gone, Trump could immediately end the CSRs simply by refusing to defend against the lawsuit. Here's what would happen then: Insurers would still be bound under the ACA to offer health-care coverage to everyone, so removing $7 billion from the equation would force them to drastically raise prices (by 19 percent, says the Kaiser Family Foundation). Or insurers might find they can't break even and exit the market.
Not surprisingly, just about everyone involved in the health-care industry - hospitals, doctors, patients and insurance companies - want the CSRs to continue, and they also want an end to the uncertainty that is already spooking the markets. Some Republican office-holders also support continuing the CSRs, apparently understanding that destroying health care in their states is not such a good idea.
But deal-maker Donald Trump is sure that jeopardizing the health care of millions will force Democrats in Congress to negotiate with him to repeal ACA, thereby killing insurance for even more millions. (Ending CSRs would reduce the number of insured by 12 million, Kaiser estimates. The Republicans' repeal-and-replace plan that fizzled last month would throw 24 million off coverage.
Trump also apparently thinks, if he explodes the ACA in full view of the American people, they will blame the Democrats, and some surely will. But a recent poll (also by Kaiser) says 61 percent will blame Republicans.
Democratic Senate and House leaders Chuck Schumer and Nancy Pelosi last week demanded that Republicans include permanent funding for CSRs in the federal budget authorization bill that Congress must pass by April 28 to prevent a partial government shutdown.
Trump's threat is reckless and cruel, but we already knew that he either doesn't know or doesn't care who will get hurt by his actions. The question is, will Republicans continue to follow him over this cliff?