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Trumpcare by Fiat: How Trump Is Trying to Derail the Health Care Law (and How Congress Can Stop Him)

This month, President Donald Trump has been rolling out a series of executive orders pertaining to the Affordable Care Act, or Obamacare. This law was an act of Congress that then President Barack Obama signed into law in 2010. Yet instead of respecting the law, Trump continues to sabotage the law with these executive actions that are designed to destroy America’s health care system.

Can Trump get away with it? That may ultimately depend upon whether Senator Dean Heller (R) and others in Congress let him.

Despite Heller’s best efforts, Trumpcare couldn’t pass Congress.

Throughout this year, Republicans in Congress have attempted to repeal Obamacare. In May, the U.S. House finally passed its Trumpcare bill, only for it to languish in the Senate.

Photo by Andrew Davey

In June, Heller joined a group of Senate Republicans who seemed dead-set against any Trumpcare bill that jeopardizes Medicaid expansion or consumer insurance protections. The next month, even as Heller buckled under Trump’s pressure, Trumpcare still failed by one vote.

Heller then joined with Senators Lindsey Graham (R-South Carolina), Bill Cassidy (R-Louisiana), and Ron Johnson (R-Wisconsin) to offer a new version of Trumpcare that would do exactly what Heller promised not to vote for. Despite intense lobbying from the White House, this Trumpcare bill failed last month without a floor vote.

So now, the White House is attempting an administrative end-run.

With Trumpcare’s chances of passing the Senate being somewhere between slim and none, Trump decided to take matters into his own hands. The White House has already cut the open enrollment period in half, and it’s ordered Healthcare.gov to go down on most Sundays during open enrollment. And just last week, Trump issued an executive order meant to undermine Obamacare’s guarantee of affordable access to contraception.

This week, Trump’s been targeting the Obamacare exchange and the overall health insurance market. On Thursday, Trump issued an executive order to encourage federal agencies to allow more employers and individuals to buy into plans off the insurance exchange that don’t meet Obamacare coverage standards. Just hours later, Trump ordered the federal government to stop making cost sharing reduction (CSR) payments that ensure that insurance plans remain affordable for all consumers who buy insurance on the exchange. Both actions jeopardize the overall insurance market by pushing younger, healthier consumers to deceptively cheap insurance plans with inadequate benefits, while leaving older, sicker consumers in the Obamacare exchange with more expensive plans.

When then President Obama took executive actions to keep the health care law working, Congressional Republicans decried them as “executive overreach”. But now that President Trump is using executive actions to cripple the health care law, most of these same Republicans are celebrating Trump’s actions, including Senator Dean Heller.

Congress can override the White House, but will they?

Now that the Trump Administration is all in to do by executive fiat what it couldn’t convince Congress to pass, Congress must decide whether it will simply allow this to happen. Even some Republicans, such as Governor Brian Sandoval (R) and Senator Susan Collins (R-Maine), have explicitly condemned Trump’s actions and urged Congress to pass bipartisan legislation to stabilize the insurance market.

After the July Trumpcare attempt failed, Senator Lamar Alexander (R-Tennessee) joined with Senator Patty Murray (D-Washington) to begin negotiations on a bipartisan proposal to prevent the kind of “health care death spiral” that Trump is trying to orchestrate now. This proposal was abandoned last month, when Senate Republican leaders opted instead to pursue the very Trumpcare bill that Senator Heller co-sponsored.

The White House is already trying to stop any new Alexander-Murray negotiations in Congress, but Congress has no obligation to follow Trump’s marching orders. Heller and his colleagues can strengthen the health care law and stabilize the insurance market if they want to. It’s up to them to answer the question of whether they want to.

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