Democrats fear Obamacare attacks, not outreach, from White House

WASHINGTON — If at first he didn't succeed in Congress, President Trump may nevertheless be poised to undercut the Affordable Care Act.

After a stinging defeat on health care in Congress last week, Trump said Tuesday night that cutting a deal with Democrats will be "such an easy one." Yet House and Senate Democrats say there's been no outreach while the White House clarifies it remains committed to repealing Obamacare. Meantime Trump could use a pending lawsuit and agency directives to help short-circuit the current health care law.

On Wednesday, White House spokesman Sean Spicer said Trump was just joking and called the GOP bill, which leaders pulled on Friday for lack of votes, "the current vessel." Democrats "also need to understand the president’s red lines," said Spicer. Earlier in the day, 44 Senate Democrats drew their own red line in a letter calling on Trump to rescind a Jan. 20 executive order, or to essentially abandon his repeal effort. It directed federal agencies to use their administrative powers to begin dismantling the Affordable Care Act “to the maximum extent permitted by law.”

“Your administration must commit to putting an end to all efforts to unravel the ACA,” the letter said. “It is clear the fight isn’t over. They are signaling they’re going to sabotage this (law),” Rep. Ben Ray Lujan, D-N.M., told reporters this week.

While the White House is making noise about compromise, Democrats are concerned that the real goal is to purposely undermine the law in a bid to force its eventual repeal. Indeed on Monday, the president predicted in a tweet that Democrats will “make a deal with me on healthcare as soon as Obamacare folds – not long.” In his Wednesday briefing, Spicer predicted that, as premiums continue to rise, it is Democrats and not the White House who will take the blame.

“They’re coming after the Affordable Care Act. They want it to fail so that their policies look better by comparison,” said Rep. Linda Sanchez, vice chair of the Democratic Caucus.

Two forces in motion

There are two forces already in motion that could deliberately impair Obamacare. How Trump navigates them will say a lot about whether he intends to work with Democrats on a solution or to try to undercut the law using his executive powers.

In mid-February, the administration said it may not reject 2016 tax returns — as previously planned — that do not indicate whether the taxpayer complied with the health law’s individual mandate. The mandate is critical tool for building a stable individual market. Americans must have a minimum level of insurance, get an exemption or pay a penalty that helps finance Obamacare.

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Another thing Trump could do to gut Obamacare — and quickly — involves a lawsuit by House Republicans to halt billions in payments insurers get under the law. In the lawsuit, which was suspended as GOP leaders pursued a replacement bill, Republicans call the payments illegal. Now that their effort in Congress has failed, the lawsuit could resume or Trump could just decline to contest it, effectively stanching the payments.

Even if Trump tries to undercut the law, there are powerful counterveiling forces that could actually help cement it. The biggest is the fact that a number of states are considering expanding their Medicaid programs. For instance, on Tuesday the Republican-dominated Kansas legislature voted to expand Medicaid and Virginia, Georgia, Maine and North Carolina are taking their own steps.

Also, some Republicans including Rep. Tom Cole, R-Okla., who chairs the appropriations health subcommittee, have said ending the insurance payments would cause too much instability in the marketplace, raising the specter Republicans could drop their lawsuit.

Finding Compromise

While the White House is insisting it wants to work with Democrats on a compromise, spokesmen for several moderate Democratic lawmakers who have proposed fixes to Obamacare, including Sens. Mark Warner of Virginia and Michael Bennet of Colorado, told USA TODAY there’s been no outreach from the White House to negotiate despite the White House rhetoric.

“They say that they’re talking to Democrats, but they’re not,” said Rep. Joe Crowley, D-N.Y., who chairs the House Democratic Caucus. The White House did not respond to a request for names after Spicer said some Democrats have reached out about ideas to “make the bill stronger.”

Many of the actions Trump and Health and Human Services Secretary Tom Price could pursue would take effect in 2018, mainly curbing outreach for enrollment, which is critical to keeping the law afloat. Another move Trump and Price could make without congressional approval would be shortening the time period for open enrollment by several weeks, depressing the number of people who buy insurance.

Even so, experts say none of these things would doom health care. “There are things that can be done administratively to increase flexibility and weaken some of the standardized and mandatory aspects of the ACA, but it is by no means a magic wand,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation.

So far

Republicans in Congress are making clear they intend to continue pressing a repeal of the law, even if there is no current path to obtaining the votes.

“The surrender caucus that was forming last Friday has dissipated and now we’re going to get back to work,” said Rep. Mo Brooks, R-Ala. He spoke after a Tuesday GOP conference meeting. “They are trying to find common ground,” he said.

That means, at least politically, the issue of replacing Obamacare remains a big political liability for Republicans.

On Tuesday, Democrats shared new polling showing Republicans failed to muster support in Congress, including from their own party, amid strong opposition from voters in battleground districts. According to the Greenberg Quinlan Rosner research, in those districts with Republican incumbents, 52% of voters disapproved of the Republican American Health Care Act. And according to surveys including Gallup, Trump saw his approval rating slide four to five points just in the past several days.

Gallup put Trump's approval rating Wednesday at 35%, a new low.

Even so, Spicer indicated on Wednesday that the plan is to charge ahead with repeal.

"It's a commitment that he made. He'd like to get it done," he said of Trump.