There are a lot of things that could blow up the young Trump presidency. Conflicts of interest abound. Russian hacking could easily become the dog that bit its owner. Foreign conflicts involving China, Russia, Israel, Turkey, or Iran all loom on the horizon. ISIS lone-wolf attacks will continue and may soon begin to focus on Trump properties here and abroad. Obamacare, however, may prove the first issue to seriously wound Trump.
Trump made a lot of promises during his campaign. He has already discounted many of them as “campaign talk”. But he isn’t going to be able to walk away from his Obamacare promise. That promise was to replace the current healthcare insurance system with “something terrific” that will provide better coverage at a lower price for more people.
His supporters are likely going to give him a pass on his conflicts of interest. They will also give him a pass if he doesn’t start building the wall right away. They won’t care if he takes a while to renegotiate NAFTA and the TPP. They also aren’t going to demand immediate action on immigration reform. He’s already told them that he isn’t going to “lock up” Clinton or Obama.
Obamacare, however, is immediate and personal.
Many of those who voted for Trump were upset about the fact that their insurance bills went up this past year.
Their expectation is that Trump is going to come up with a better plan which will provide them insurance which meets their needs at a price they can afford. They are unhappy with high deductible plans. They are unhappy with lack of choice. They are also unhappy with the perception that poor people are getting a better deal through Medicaid than they are.
Health care, for all its tediousness, is extremely emotional. Sickness brings out our most vulnerable selves. When the system built to keep you alive lets you down, the urge to start afresh can be irresistible.
“I hope that Mr. Trump is working with someone as we speak on this,” Starry said. “Figure it out, guys. That’s what we hired you to do.”
The problem is that Trump is not going to be able to immediately change the fundamental economics that are driving growth in healthcare costs. Obamacare was originally passed to address the fact that healthcare costs were growing much faster than the overall economy. Obamacare has been effective in slowing the growth of healthcare costs, but it has been a very delicate balance. Recent premium increases under Obamacare reflect a couple of important facts. The risk mix between low cost and higher cost people is still too high for insurance companies. Small business did not exit the insurance market, as many predicted. So a higher number of younger healthier working people are getting their insurance from their employers rather than through the Obamacare exchanges. Also the number of younger healthier people willing to just pay the penalties is higher than projected. As a result, insurance companies are raising their rates to offset the higher costs of care for their insured populations.
Trump’s second problem with Obamacare is just as large as his first one. Conservative Republicans have their own agenda that goes well beyond Obamacare. Repealing Obamacare is just the first step in the conservative Republican plan to unravel the social safety net that they feel leads to dependency. They are not particularly interested in replacing Obamacare with anything. If they are able to repeal Obamacare without offering a viable alternative, they will next take aim at privatizing Medicare and Social Security.
If Trump is unable to focus his majority on tax reform, immigration, and jobs — they will happily spend their time and his political capital on their ideological agenda.
That will spell doom for Trump and his Republican majority.
Those voters who were angry about increases in their premiums in 2016 will be outraged when their policies are canceled, there are no affordable options, and insurance companies resume denying care for those they perceive as high risk.
If the Trump Congress follows a “kick the can on replacement” Obamacare repeal with suggestions on how Medicare and Social Security can be “improved”, the furry will reverberate across the country. The backlash will be worse than the 2010 Tea Party revolt. Voters will punish Trump and Republicans in 2018. If Trump manages to survive until 2020, he will lose in a landslide to Elizabeth Warren or whomever else the Democrats end up nominating.