To the relief of many Democrats and the consternation of many Republicans, Congress will not be repealing ObamaCare this month. But that doesn’t mean Democrats are riding high or that ObamaCare is doing well. Premiums are still rising rapidly (Miami Herald: "Obamacare Premiums in Florida to Rise 45 Percent on Average Next Year"), insurers are still leaving the Exchanges (Healthcare Marketplace: "Nearly Half of the Country Left with One Carrier Option in 2018"), and ObamaCare coverage is still becoming a worse and worse deal for the sick (Wall Street Journal/yours truly: "How ObamaCare Punishes the Sick").
Now that repeal is no longer an immediate threat, the conversation has naturally turned to who’s to blame for ObamaCare’s failings. Democrats claim everything was going swimmingly until the Trump administration came along and began sabotaging the law. The funny thing about that line of attack is that’s if it were true, then Democrats’ real complaint would be that voters are sabotaging ObamaCare.
But it’s not true—and reporters should stop repeating this partisan line of attack as if it were. Here are five crucial points:
- The Trump administration is not causing the instability we are seeing in the Exchanges—ObamaCare is. Specifically, ObamaCare’s community rating price controls have both unleashed adverse selection (sick people enroll, healthy people don’t) and are making coverage worse for the sick (as insurers use plan design to deter the sickest from choosing their plans). There are only two ways to deal with that instability: eliminate community rating, or subsidize the heck out of insurers (either explicitly, or implicitly by encouraging healthy people to enroll).
- The Trump administration is not stoking the instability ObamaCare is creating in the Exchanges. Democrats claim that by not ending the uncertainty surrounding cost-sharing subsidies to insurers, and by not investing in enrollment activities as much as the Obama administration did, it is in fact the Trump administration that is creating or exacerbating that instability. That is false. As noted above, it is ObamaCare's community-rating price controls that are creating this instability, not the Trump administration's actions. The administration is not even adding to the instability. To do so, it would have to make ObamaCare’s community-rating price controls even more binding, which would exacerbate adverse selection. The worst you can say about those actions is that the Trump administration is failing to mitigate the instability ObamaCare creates, which brings us to our next point.
- The Trump administration does not have a duty to reduce the instability ObamaCare creates, or to reduce the uncertainty ObamaCare creates, or to make ObamaCare "work." The Trump administration's only duty is to execute the law faithfully. So long as it does, it has the prerogative to pursue its political goals however it wants. I’m not aware of anyone accusing the Trump administration of not following the law in its handling of ObamaCare.
- Reporters who say the Trump administration is causing or stoking instability in the Exchanges are simply regurgitating partisan talking points. Embedded in that claim is the normative, disputed, and ultimately false premise that the Trump administration somehow has an obligation not just to follow the law, but to make ObamaCare "work." That is a pretty radical notion, because it implies ObamaCare opponents don't have a right to use lawful means to press their views through the political process.
If Democrats or the media want to get angry at someone for sabotaging ObamaCare, there are plenty of targets. They can start with the Democratic politicans who -- though they now clamor for bipartisanship now -- enacted ObamaCare in 2010 on a purely partisan basis, spent seven years refusing to compromise, and as a result sowed the seeds for the GOP's electoral gains. Then there's the Democratic president who -- and this was perhaps the sole exception to Democrats' general refusal to compromise -- himself sabotaged the law by agreeing to limit so-called "risk-corridor" subsidies to ObamaCare carriers. Then there was the time when ObamaCare was making voters so angry, that same Democratic president even violated the ACA by allowing people to keep non-ACA-compliant plans. That decision counts as an act of double-sabotage, because it continues to make Exchange premiums higher than they otherwise would be.
In short, ObamaCare still doesn't work well; it isn't popular enough for Congress to paper over all its problems with more taxpayer dollars; Democrats did this to themselves; and they deserve nearly all, if not all, of the blame.
Now stop making me defend the Trump administration, people. Sheesh.