You may have heard that Obamacare is “failing,” but really, it’s proved remarkably durable. The law has survived a flubbed rollout, uncooperative conservative state lawmakers, two legal challenges brought to the Supreme Court, more than 50 repeal votes in the House, and, at least for now, a rushed and secretive legislative onslaught from the Republican-controlled House, Senate, and White House.
Even after the collapse of Senate Republican’s most recent attempt to gut the law, however, Obamacare’s future—and the well-being of the millions of people who depend on it for insurance coverage—is uncertain. Senate majority leader Mitch McConnell initially said he would hold a vote next week on a bill to fully repeal Obamacare with nothing to replace it. That plan was immediately doomed, as several Republicans vowed to vote against repeal-only legislation. On Wednesday night, a group of GOP senators huddled in search of a way to revive the stalled replacement bill. The plan, reportedly, is to buy off their reluctant colleagues.
However the vote goes next week—if it goes at all—there’s plenty the Trump administration can do behind the scenes to cripple the health-care law. “We’ll let Obamacare fail and then the Democrats are going to come to us,” Trump told reporters on Tuesday. “Let Obamacare fail” really means make it fail—a strategy the Trump administration has been flirting with for months. In April, Trump threatened to cut off payments to insurers (known as cost-sharing reductions) that help to lower out-of-pocket costs for lower-income people. If he does so now, insurers would either raise premiums, or exit the market completely. Trump could also choose not to enforce the tax penalties for people who forgo insurance, or not to advertise enrollment periods, both of which would destabilize markets even further.
Yes, Obamacare’s individual marketplaces are already unstable in some areas. There may be no insurers offering plans in more than three dozen counties in Indiana, Nevada, and Ohio next year, and only a single insurer in others. Premiums are expected to rise. But a more basic problem is that the people now overseeing Obamacare would like to see it fail—specifically Health and Human Services Secretary Tom Price and the administrator of the Centers for Medicare and Medicaid Services, Seema Verma. Both trumpet any bad news about the “collapsing” markets, while doing nothing to stabilize them. Insurers themselves have explained that the Trump administration’s actions (or lack thereof) are one of the primary reasons for instability and premium hikes.