Trump Personally Tried to Sabotage Obamacare in Iowa

By Eric Levitz, New York Magazine

07 October 17

 

owa has a plan to stabilize its Obamacare marketplaces by transferring insurance subsidies away from low-income people and toward the middle class, while also setting up a reinsurance program to limit insurers’ losses.

Progressives hate the proposal. But the conservative Republicans who wrote it think it’s grand — and, critically, so does the state’s largest insurer, Wellmark Blue Cross and Blue Shield, which has promised to reverse its plan to leave the state’s individual insurance market if the reforms are put into effect.

In its broad outlines, Iowa’s proposal would do much of what every version of Trumpcare has aspired to: bring down premiums for middle-class people aggrieved by their lack of access to Obamacare subsidies; screw over the poor; and please insurers.

And yet, when President Trump got wind of the plan in late August, he ordered his Health department to kill it. As the Washington Post reports:

For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application.

Trump’s message was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.

… It was a Wall Street Journal article about Iowa’s request that provoked Trump’s ire in late August, according to an individual briefed on the exchange. The story detailed how officials had just submitted the application for a Section 1332 waiver — a provision that allows states to adjust how they are implementing the ACA as long as they can prove it would not translate into lost or less-affordable coverage.

Iowa’s aim was to foster more competition and better prices. The story said other states hoping to stabilize their situations were watching closely.

Trump first tried to reach Price, the individual recounted, but the secretary was traveling in Asia and unavailable. The president then called Seema Verma, administrator of the Centers for Medicare and Medicaid Services, the agency charged with authorizing or rejecting Section 1332 applications. CMS had been working closely with Iowa as it fine-tuned its submission.

Now, there’s a strong case that Iowa’s waiver request should be denied — its proposed reforms are so right-wing, they may actually be illegal. “The courts won’t stand for this,” health-care law expert Nicholas Bagley wrote last month. “The [Affordable Care Act’s] guardrails are really restrictive …they suggest that a state’s waiver can be approved if and only if it doesn’t make a substantial number of people worse off than they were under the ACA. Iowa’s waiver flunks that test.”

But it’s highly unlikely that Trump tried to block the waiver out of deference to the letter of Barack Obama’s law. While the Journal did mention opposition from the National Alliance on Mental Illness and the American Cancer Society toward the bottom of its story, the article’s main thrust was that Iowa’s plan would keep its largest insurer in all of its counties, reduce premiums for the middle class, and serve as a potential model to other Republican-controlled states looking to strengthen their exchanges.

Given that the Trump administration is now openly sabotaging the Affordable Care Act, it’s safe to assume that the president tried to kill Iowa’s request for the very worst of reasons. In recent weeks, Health and Human Services has spread doubt about whether it will enforce the tax penalty for refusing to sign up for insurance; cut funding for the law’s outreach groups; slashed Obamacare’s advertising budget by 90 percent; spent a portion of the remaining ad budget on propaganda calling for the law’s repeal; cut the open-enrollment period by 45 days; announced that it would be taking healthcare.gov (where people can enroll in Obamacare online) offline for nearly every Sunday during that time period, for “maintenance” purposes; instructed its ten regional directors not to participate in state-based events promoting ACA enrollment; and, when asked about their rationale for pulling out of those events, released a statement saying, “The American people know a bad deal when they see one and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford.”

And the president’s most ambitious act of sabotage may still be to come. Under Obamacare, participating insurers are required to keep deductibles and co-payments affordable for low-income people. In practice, this means that insurers must underprice the risk of covering such individuals, and, thus, accept a financial loss. To make that proposition more appealing to these for-profit companies, Obamacare provides them with “cost-sharing reductions” — subsidies that defray the insurers’ losses.
But for complicated reasons relating to a lawsuit that House Republicans brought against the Obama administration, Donald Trump can cancel those subsidies at will. And he has threatened to do just that, over and over again, for months. These threats, alone, have led many insurers to either pull out of the exchanges, or else jack up premiums high enough to offset the costs of covering low-income enrollees without Uncle Sam’s help.

But, according to the Post, the number of insurers participating in Obamacare is still too high — and the premiums on its plans still too low — for the Trump administration’s taste: A White House aide told the paper Thursday that “officials are considering action to end the payments in November.”

It’s still possible that Iowa’s waiver will be approved — the White House has yet to formally reject it. Regardless, the fact that Trump intervened directly to block it has two significant implications. First, it establishes that the administration’s sabotage campaign won’t end with Tom Price’s tenure at HHS (this thing goes all the way to the top). Second, it confirms that Trump’s approach to Obamacare is not ideological, but wholly egotistical.
Iowa wanted to subvert the ACA for the sake of advancing a version of Trump’s own ostensible health-care agenda. The president scrambled to block it because he has zero interest in promoting any particular health-care policy — last week, Trump said at a high-dollar fundraiser that he was thinking “I might very well end up making a deal with the Democrats,” because Republicans hadn’t been able to put a health-care bill on his desk.

Which is to say: Our president isn’t deliberately increasing the number of Americans who will go without insurance next year so as to advance an ideological project, but solely out of a (likely misguided belief) that doing so will increase his chances of one day writing his name on a fancy-looking document — and declaring Barack Obama’s signature achievement officially dead.

Say what you want about the tenets of movement conservatism, at least it’s an ethos.

Memo to Tillerson About the Moron

By Robert Reich, Robert Reich's Blog

07 October 17

 

o: Rex Tillerson
From: Robert Reich
Subject: The Moron

I can understand why you feel Washington is a place of “petty nonsense,” as you said Wednesday when you called a news conference to rebut charges that you called Trump a moron last summer after a meeting of national security officials at the Pentagon.

I’m also reasonably sure you called him a moron, which doesn’t make Washington any less petty. You probably called him a moron because almost all of us out here in the rest of America routinely call him that.

But you’re right: There are far more important issues than the epithet you likely used to describe your boss.

On the other hand, your calling him a moron wouldn’t itself have mushroomed into a headline issue – even in petty Washington – if there weren’t deep concerns about the President’s state of mind to begin with.

I bet every cabinet secretary has from time to time called his boss a moron. I was a cabinet secretary once, and although I don’t recall ever saying Bill Clinton was a moron, I might have thought it, especially when I found out about Monica Lewinsky. But Bill Clinton was no moron.

The reason your moronic comment about Trump made the headlines is that Trump really is a moron, in the sense you probably meant it: He’s impulsive, mercurial, often cruel, and pathologically narcissistic. Some psychologists who have studied his behavior have concluded he’s a sociopath.

Washington is petty, but it’s not nonsensical. It latches on to gaffes only when they reveal something important. As journalist Michael Kinsley once said, “A gaffe is when a politician tells the truth – some obvious truth he isn’t supposed to say.”

Face it. You are Secretary of State – the nation’s chief diplomat – under a president who’s dangerously nuts.

Last weekend, for example, Trump publicly said you were wasting your time trying to open talks with North Korea. Does he have a better idea? Any halfway rational president would ask his Secretary of State to try to talk with Kim Jong-Un.

And there’s Iran. You and Defense Secretary James Mattis have both stated the nuclear agreement should be retained. That, too, is only rational. The International Atomic Energy Agency says Iran has been honoring the agreement. Without it, Iran would restart its nuclear program.

But Trump is on the verge of decertifying the agreement in order to save face (in the 2016 campaign he called it an “embarrassment to America”) and further puncture Barack Obama’s legacy. His narcissism is endangering the world.

You tried to mediate the dispute between Qatar and its Arab neighbors. That, too, was the reasonable thing to do.

But then Trump and his son-in-law Jared Kushner sided with the United Arab Emirates, where they have business interests. Less than one hour after you called for a “calm and thoughtful dialogue” between Qatar and its neighbors, Trump blasted Qatar for financing terrorism. That was also nuts.

You are rightly appalled at Trump’s behavior. I can understand why you distanced yourself when Trump blamed “both sides” for violence at a white supremacist rally in Charlottesville. And why you were horrified when Trump gave a wildly partisan speech to the Boy Scouts of America, which you once headed.

Given all this, I’m not surprised to hear that you’ve talked about resigning, but that Mattis and John Kelly, the White House chief of staff, have talked you out of it.

I urge you not to resign. America and the world need sane voices speaking into the ear of our Narcissist-in-Chief.

As Senator Bob Corker, Republican of Tennessee and chairman of the Foreign Relations Committee said recently, it’s you, Mattis, and Kelly who “help separate our country from chaos.” I don’t think Corker was referring to chaos abroad.

Let Trump fire you if he wants to. That would further reveal what a moron he is.

But if you really did want to serve the best interests of this nation, there’s another option you might want to consider.

Quietly meet with Mattis, Kelly, and Vice President Pence. Come up with a plan for getting most of the cabinet to join in a letter to Congress saying Trump is unable to discharge the duties of his office.

Under the 25th Amendment, that would mean Trump is fired.