Now that Trumpcare has failed, it’s time to drop all the lies

It’s fitting that President Trump reacted to the epic collapse of the GOP repeal-and-replace push by vowing to keep up his campaign to sabotage the Affordable Care Act. “Let Obamacare implode, then deal,” Trump tweeted, meaning the administration should continue undermining the law, to force Democrats to the table to … well, it’s not clear what he wants from them, but it is clear is that he will continue sabotaging the ACA out of sheer rage and spite.

For Trump, this has never been about improving our health-care system. Trump, who visibly had no idea how the ACA works or what was in the various GOP replacements, and who openly said he would sign whatever Republicans put in front of him, just wanted to boast of a “win” while triumphantly using Barack Obama’s signature domestic achievement as his own personal toilet paper roll.

Trump has not yet secured that opportunity for himself. The “skinny repeal” bill failed, after Sen. John McCain cast the dramatic vote against it that, along with the opposition of Sens. Lisa Murkowski and Susan Collins, sealed its fate, and for now, the fate of the GOP repeal push. Trump raged that all Democrats and three Republicans had “let the American people down.” But this outcome, ironically, was good news not just for the United States, but also for untold numbers of Trump’s own voters, the low-income and aging whites who also benefited from the ACA’s historic coverage expansion. Trump’s voters were spared the destructive impact of his peculiar combination of ignorance, megalomania and sheer indifference to the fate of millions.

Trump’s threat to keep sabotaging the ACA, however, could actually still end up hurting a lot of people. There are plenty of tools that the administration can employ to keep sabotaging the individual markets and the ACA. Politico has a good rundown: The administration can do too little to promote enrollment or scale back enforcement of the mandate or give states more leeway to experiment with Medicaid in destructive ways. The administration can continue to refuse to guarantee cost-sharing reductions, which has already caused insurers to exit the markets and hike premiums, something that could continue or get worse, leaving many more people without coverage options. Insurers are already warning of such an outcome.

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