WASHINGTON (Sinclair Broadcast Group) — After House Republican leadership had to pull the American Health Care Act (AHCA) from a vote on Friday, President Donald Trump indicated that his plan B would be to wait for the Affordable Care Act to collapse before making another legislative push for health care reform. But according to experts, Trump will be hit with the political fallout if he allows the American health care system to explode under his watch.
Late last week, the White House said that their health care bill represented the only opportunity for Republicans to repeal and replace the Affordable Care Act (ACA), a campaign promise many conservatives have been making since the law was implemented in 2009.
With the failure of the bill to repeal and replace Obamacare, the White House is arguing that it will allow the program to collapse under its own weight. Under those more dire conditions, the opponents of the president's health care plan, both on the Republican and Democratic side will come back to the negotiating table.
"I've been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode," Trump said on Friday after his health bill was pulled from consideration by the House. The collapse of Obamacare is imminent, he argued, unless Democrats get on board with Republicans to "get a real health care bill," something he says could come "in the not-too-distant future."
The more Trump insists that Obamacare will "explode" in the near future — even as soon as 2017 — the more it would appear that negotiations on health care are still open, especially for lawmakers whose constituents elected them no a promise to fix America's broken health care system.
Over the weekend, Trump surrogate and former House Speaker Newt Gingrich suggested that Trump should have made a more direct appeal to the people on the country in passing his health bill, instead of trying to work a solution within the Washington beltway.
"I hope that this will be a moment in the Trump presidency when they realize that they can’t win an inside game," Gingrich said on Fox News Sunday. "Trump's great strength is in the country, as Reagan’s great strength was in the country." He laid out a set of ground rules for selling Trump policy including, "start with the country understanding what you're doing and then try to do it in Washington."
The idea of Trump trying to sell a replacement healthcare bill now, in the immediate aftermath of the AHCA defeat, is politically unfeasible, said Joseph Antos a health policy scholar at the American Enterprise Institute.
"Saying Trump should go out and sell his plan ... that's selling the horse after the horse was shot," Antos said.
After the AHCA was rejected by the Freedom Caucus, moderate conservatives, and even some rank and file Republicans, Antos advised, "You can't resell the thing that was rejected politically by your own party."
After suffering political defeat on Friday, "they're going to take a relatively low profile on healthcare I think, for political reasons," he explained. Given the entrenched political views and practical difficulties of health care reform, Antos said he doesn't anticipate the administration will make another foray into health care reform for at least the next 3 1/2 years.
As of Friday, a number of House Democrats told Sinclair Broadcast Group that they were open to work with their Republican colleagues to fix the obvious problems with Obamacare, including the spiraling costs of premiums, collapsing exchanges and the decline in the number of insurance plans available in many parts of the country.
On Sunday, Senate Minority leader Chuck Schumer indicated that he too would be open to working with Republicans and the White House, but only if they abandon their years-long position of fully repealing the Affordable Care Act.
Schumer argued that "of course" Obamacare can be improved, "and once the Republicans take repeal off the table, we're willing to work with them to improve it."
According to Shana Kushner Gadarian, political science professor at Syracuse University, it is "extremely unlikely" to expect Republicans to rework the health care reform in a way that takes repeal off the table, just to try to sway a few moderate Democrats. On the other side of the aisle, Democrats just don't have the political incentive to work with Republicans.
"From the perspective of the public, the Republicans promised several times to repeal and replace the Affordable Care Act, and from a political perspective, the Democrats don't own health care anymore, the Republicans do," she said.
President Trump tried to portray the Democratic Party as the big losers on Friday who should be held responsible as the system allegedly blows apart. He argued that the Democrats, the architects of the Affordable Care Act, are responsible for the rising costs and worse coverage many patients are experiencing, not to mention the growing costs to government of subsidizing more expensive health plans.
"Regular politics would tell you that's a bad strategy all around," Gadarian said of the White House messaging. "People are going to see harm in their own lives and to the government, and they're going to blame the people who are in charge now, which is the Republican majority."
That is why she anticipates the most likely approach the White House will adopt is "death by a thousand cuts." Using the powers given to the Secretary of Health and Human Services Tom Price, the administration can subtly undermine the ACA. For example, HHS controls the disbursement of subsidies to insurers who provide care to lower income Americans. By not providing or increasing those funds, insurers would further lose the incentive to remain a part of the exchanges.
Such steps would help quicken the explosion of Obamacare, which Trump often refers to as inevitable, and through small regulatory tweaks, the administration might "deflect blame," but only if the public can't determine the cause of their health care collapse.
Gary Claxston, vice president of the Kaiser Family Foundation, a prominent health policy organization, said that the administration has a number of options open to it if it wishes to preserve the Affordable Care Act or begin to disassemble it.
For example, if they wanted to help bring insurers into states where there are currently limited coverage options, they could adjust subsidies. They could also increase outreach and advertising to boost overall enrollment. Each of those steps would bolster the existing health care system.
"There are a million details that come in when implement a program, it's how they follow through on those," Claxton said. "Are they trying to help keep the program working or are they not?"
Although Claxton does not see the ACA exploding, as Trump has suggested, he noted there are ways to "administer something in a grudging way" that makes the health care system less effective. "But the more you do that, the more the problems become your own," he warned. Additionally, all those individuals sworn into office still have the responsibility to uphold the law, which is Obamacare.
Throughout the weekend there was plenty of blame to go around. Trump and the White House pit the blame on Democrats. Many Republican leaders, including Speaker Ryan, blamed the Freedom Caucus for opposing the AHCA. Freedom Caucus member, Rep. Ted Poe (R-Tex.) defected from the opposition to support the White House bill. He accused his caucus of "letting the perfect be the enemy of the good" and failing to step into their new role as legislators, not just the party of no.
But in the immediate aftermath of the Freedom Caucus' showdown with the White House, the leader of that group Rep. Mark Meadows (R-N.C.) returned to his district to a hero's welcome. His constituents supported him for holding out against a bad bill.
Even though Donald Trump accused the opposition Freedom Caucus of upholding Planned Parenthood, an unpopular position, in firmly Republican districts, those members are not likely to be frightened by a tweet.
"It's the moderates I think that have the most to lose," Antos warned. Those are the lawmakers who are most likely to see their seats threatened in the upcoming 2018 midterm elections.
"If their districts are purple rather than red or blue, then the question is going to be, what did you do in these two years? What did you accomplish? What did you bring home to the district?" he continued. If they don't have a good answers to those question, their constituents may throw them out of office.
Additionally, the Republican party, which has been the opposition party for the last 10 years under a Democratic White House and Democratic control of Congress, needs to learn to govern. As Paul Ryan said on Friday, "Being against things was easy to do," but now the party is challenged with the task of governing.
"If it continues to be the case that the Republican Party is looking like its having trouble governing, that they can't push these major pieces of legislation through that they promised," Gadarian said, "I think it will be bad in 2018 for the party."