These assurances conveniently ignore the basic facts of California v. Texas — in which the plaintiffs argue the entire ACA should be struck down as a result of its individual mandate penalty being brought to zero in 2017 legislation. That lawsuit has the full support of the Trump administration and 18 Republican-led states, and has already received favorable rulings from conservative, lower-court judges — whom these same senators helped install. These assurances also paper over the Senate Republicans’ recent vote rejecting a measure to halt federal support for the lawsuit. All of this fits into a larger pattern: Since he took office, Trump’s budgets have called for not only repealing the Affordable Care Act, but even deeper cuts to the Medicaid program. But when it comes to Trump’s plans for health care, the best thing he and his Republican allies have going for them is skepticism that they can pull them off.
Proposals to do away with the ACA’s protections are deeply unpopular — in the years since its passage in 2010, both the ACA as a whole and its individual components have gained public support. Trump has nonetheless benefited from a common narrative that his attacks on the Affordable Care Act are mere posturing. His bombastic tweets, his confusing insistence that Obamacare is already gone, and his empty promises to protect preexisting conditions have created a misleading impression that Trump has done little to change health-care policy beyond rebranding existing law. But the truth is that Trump’s opposition to the Affordable Care Act is not simply rhetorical — in fact, his policy record reflects a maximally aggressive approach to undoing the law through every legislative, administrative, and judicial channel available.
That started with the administration and its congressional allies using their precious year-one political capital to try to repeal the law through Congress. But for an unexpected, last-minute thumbs-down from Sen. John McCain (R-Ariz.), the Trump White House, the Republican House and 49 Republican senators were ready to proceed with undoing the ACA even though they never agreed on the “replace” part of their “repeal-and-replace” promise. In the wake of that legislative failure, the Trump administration pushed on by taking aggressive actions on its own to limit access to health care. One of the cruelest was urging states to put in place work requirements for Medicaid — measures that have been shown to significantly reduce health coverage without actually increasing employment. (Before a judge stayed work requirements in Arkansas — the first state to put them in effect — 18,000 adults had lost coverage in the first year.)
The Trump administration’s concerted effort to undermine participation in the ACA marketplaces — by rolling back outreach efforts, shortening open enrollment periods, and removing the individual mandate — has, by design, reduced the number of people enrolled. And the administration has taken steps to expand short-term coverage and “association health plans” that are not required to abide by ACA rules protecting people with preexisting conditions or limiting insurance company profits —