How the Democrats Can Still Save Obamacare

It’s all about the blame game.

Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi in Washington on Oct. 4.

Chip Somodevilla/Getty Images

Between an executive order instructing federal departments to find new ways of undermining Obamacare and an official announcement that the administration would no longer reimburse insurers to reduce out-of-pocket costs for lower-income Obamacare enrollees, Thursday was President Trump’s most productive day of impetuous health care vandalism yet. The back-to-back moves crystallized what the administration has been signaling throughout the year: Obamacare may remain on the books, but this administration will not manage it in good faith. Why should insurers still bother participating?

Democrats responded quickly to the moves by laying blame for a tattered health care system at Republicans’ feet.

“Republicans have been doing everything they can for the last 10 months to inject instability into our health care system and to force collapse through sabotage,” Senate Minority Leader Chuck Schumer told reporters Friday morning, “and Republicans in the House and Senate now own the health care system in this country from top to bottom, and their destructive actions, and the actions of the president, are going to fall on their backs.”

He noted that “6 in 10 Americans said that the president and congressional Republicans are responsible for any problems with the health care system going forward” and warned congressional Republicans that, for their own sake, they should appropriate the cost-sharing reductions that the administration just announced it would stop paying itself.

“Unless our Republican colleagues act,” Schumer said, “the American people will know exactly where to place the blame when their premiums shoot up, and when millions lose coverage.”

It may seem crass to point fingers and taunt Republicans about how badly they’re going down. But the blame game is everything right now. It will determine whether the Affordable Care Act can get off the mat and endure. If Democrats can’t make them own the sabotage, the sabotage will endure instead.

Gauging political “ownership” of the health care system right now is tricky and explains why each side currently believes it possesses the winning case. The survey Schumer mentioned was the Kaiser Family Foundation’s August tracking poll, in which 60 percent of respondents said that Republicans “are responsible for any problems with the ACA moving forward,” versus 28 percent who said that Democrats would still be responsible since Obamacare is their baby. Those numbers look like decisive leverage for Democrats going forward. But the poll came out immediately after Senate Republicans had made fools of themselves failing to pass health care legislation, and memories are short.

The bet that Trump and conservative Republicans are making is that voters—specifically middle-class consumers on the individual market exchanges facing, in many cases, ridiculous premium increases in 2018—will resort to the norm of the past few years: blaming Obamacare, and Democrats, for every exorbitant medical bill they face. This fits into the GOP’s continuing pursuit of repeal: We tried to fix the system, Democrats wouldn’t help us, and now you’re stuck with the same old Obamacare crap. Central to this political strategy is the obscure art form known as “lying,” in which it’s never mentioned that the administration and allies in the congressional majority have taken direct steps to sabotage Obamacare and create this political argument for themselves.

They are, in short, hoping that no one is paying attention.

You will know if Democrats have successfully convinced the public that Republican sabotage of the Affordable Care Act is to blame for high premiums when congressional Republicans suddenly scramble to inject money into it. Appropriating the cost-sharing reduction payments will no longer be something congressional Democrats have to grind for in spending negotiations; vulnerable Republicans will insist on them, too. The Senate negotiations on a short-term market stabilization bill between Washington Sen. Patty Murray and Tennessee Sen. Lamar Alexander will reach a deal and move through Congress. Republican leaders might act as though they’re taking these steps reluctantly, but they’ll be doing it to protect their majorities. Democrats’ effort to stick the blame on Republicans in these next few months isn’t the usual gamesmanship—it’s the entire game. If they succeed, Obamacare will survive; if they fail, the purposeful unraveling will continue until there’s little left.