On Tuesday, Sens. Lamar Alexander and Patty Murray unveiled a bipartisan bargain to temporarily stabilize Obamacare’s insurance exchanges, and potentially head off dramatic premium increases in 2018. At first President Trump, whose own attempts to blow up the markets helped lead to the bill, seemed supportive. But then he began to backtrack, and by day’s end, seemed to reverse himself entirely, knocking the proposal as a “bailout.” On Wednesday morning, he enshrined his new stance in a tweet:
Trump’s tweet obviously bodes poorly for the stabilization bill’s political future. It is also absolutely incoherent. And while “Trump spouts nonsense” is by now a dog-bites-man story, it’s worth dwelling on just how divorced from reality his reasoning seems to be.
First, Alexander-Murray is not a bailout. The bill is, in fact, the exact opposite of a bailout—it is merely an attempt to pay insurers money that they are supposed to receive under Obamacare in return for offering discount coverage to low-income customers, and that Trump cut off last week in his latest, most severe attempt to bring the market crumbling down. These subsidies (which Trump has inaccurately referred to as a “bailout” for months) have been the subject of a partisan legal battle, but one way or another insurers are almost certainly entitled to them as a matter of law. If carriers don’t don’t get them with Congress’ blessing, they will probably get them through the courts.
To put it another way: Paying companies money that they are legally owed in return for their services is not a bailout. Hence, Alexander-Murray is not a bailout.
Second, insurance companies have not “made a fortune” from Obamacare. Until this year, that was arguably the single biggest problem with the program. Insurers kept losing money and thus kept having to raise premiums. It seemed like prices were set to settle this year as companies got closer to profitability, but then Trump came along and wrecked the market like a huffy 8-year-old kicking over his older sibling’s sandcastle.
Third, you typically do not bail out companies that have “made a fortune,” unless—as with banks during the financial crisis—they have done so by taking exorbitant risks that have finally come back to haunt them. It is hard to imagine exactly how such a scenario would unfold in the extremely cautious health-insurance business.
As always, it is possible that Trump understands all of this, and is once again relying on the phrase bailout for rhetorical purposes, because he thinks any hint that he has saved Obamacare will be toxic with his base and needs an excuse to kill the deal. But it is also possible that Trump has constructed his own alternative reality in order to justify his decision to unleash havoc on the U.S. health care system—and since his mind is basically a refrigerator door covered in magnetic poetry written by Fox & Friends, this imaginary world makes no sense.