President Donald Trump often blasts Obamacare as a total disaster, a pathetic failure doomed to implode. But sometimes he adds a twist, suggesting that instead of trying to fix the situation, Republicans would be smarter to exploit the situation. “Let it be a disaster, because we can blame that on the Democrats,” Trump mused to the National Governors Association on February 27. “Let it implode, then let it implode in 2018 even worse … Politically, it would be a great solution.”
Trump has made similar remarks on Twitter, at the Conservative Political Action Conference, in an Oval Office meeting last week with conservative activists, and at a Roosevelt Room event on Monday with Americans who don’t like Obamacare. He keeps emphasizing that Republicans are “putting themselves in a very bad position” by pushing a controversial repeal bill, when they could easily let Obamacare collapse and let Democrats take the blame. He’s been saying this kind of thing so often that it’s worth asking whether he’s taking his own advice, trying to sabotage Obamacare for political reasons.
It’s clear that Obamacare has become less stable since Trump’s election, with several insurers expressing new doubts about offering coverage on government-run exchanges. It’s also clear that this instability is central to Trump’s case for repeal, as he argues that the current state of the health care system is so catastrophic that Congress needs to pass a House Republican bill that was floundering on the Hill even before Monday’s blistering report from the Congressional Budget Office.
What’s less clear is how much Trump is intentionally contributing to Obamacare’s problems. Trump has said he’s resisting the temptation, because “we have to do what’s right,” and the White House sent me its three-pronged health care plan (including “regulatory reforms to stabilize insurance markets”) as proof. But the president has already done several things that undermine Obamacare—weakening enforcement of its insurance mandate, canceling its latest ad campaign and intensifying uncertainty about its future—although not everything he’s done has undermined it.
In any case, Obamacare is facing its most serious crisis since it launched with a dysfunctional website in 2014. Insurers will decide later this spring whether to continue offering coverage on Obamacare’s exchanges, and the combination of Trump’s election, the Republican push for repeal and the new administration’s early efforts to undercut the law has created new fears of the kind of mass exodus that GOP critics have been predicting for years. Even if the repeal bill stalls in Congress, Trump will have a lot of power to try to deepen Obamacare’s problems and enhance his argument for repeal—or to try to solve the problems and take a different type of victory lap. Trump keeps insisting that a collapse would be great news for Republicans, because it would highlight the incompetence of Democrats, while heightening the need for reforms that would reduce costs and improve care. But even setting aside the policy implications of such a massive upheaval, some experts question Trump’s political analysis.
“They must know sabotage won’t work now that they control Washington,” says Steven Ullmann, a health policy professor at the University of Miami business school. “It’s like Colin Powell said about Iraq: You break it, you own it.”