Last Friday, after the Senate yet again failed to repeal Obamacare, Trump tweeted:
3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!
— Donald J. Trump (@realDonaldTrump) July 28, 2017
Trump realizes that this isn’t going to “implode” on its own. Republicans have been doing everything they can since it was passed to try to kill it, without success. For months, he’s been toying with insurers, suggesting that he would stop reimbursing them for cost-sharing reduction subsidies.
The Affordable Care Act requires that insurers help cover the out of pocket costs for poor members, and says the government will reimburse insurers for these expenses. If Trump stops payments, then insurance companies will be on the hook for these costs. This uncertainty is a major part of the reason that insurers across the country are dramatically increasing their rates for next year. If Congress doesn’t act, this is Trump’s best chance to screw up people’s health insurance.
Who will be hurt the most? An analysis based on data from the Centers for Medicare & Medicaid Services shows where the people will be hurt the most:
As with so many of Trump’s attempts to dismantle Obama’s legacy, his screwing with health insurance would overwhelmingly hurt the red states that voted him into office. He would hurt the ones who support him most.
Nationally, 57 percent of people who buy insurance through the exchanges get cost-sharing reduction subsidies, but in individual states, the number ranges from 16.4 percent to 77.6 percent. The top ten states include all of the Deep South, Idaho, and Utah. If Trump follows through, those will be the states where rates will rise the most.
Of course, Trump’s approach is based on the magical thinking that a collapse of Obamacare will somehow fix the divisions in his own party. The plans that Congress has considered so far would all hurt Americans more than what Trump can do by withholding these payments.