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Trump admits that sabotage is real Republican health care plan

A shared passion for uninsuring Americans has held together a party often on the verge of leaping from Civil War reenactors into a full-blown civil war.

President Donald Trump is threatening to end what he called "bailouts" for health insurers and Congress.Video provided by Newsy Newslook

Trump is GOP truth-teller on health care. He says what most in the party think.

President Trump.(Photo: Evan Vucci, AP)

Donald Trump wants you to pay more for your health insurance. And if you don’t let him get away with it, he’ll make you pay more for your health insurance. Higher premiums or higher premiums – Trump lets you have your pick.

This pouty lust for vengeance on the American people’s wallets and health care may seem unique to the pouty president, but it has been the prime directive of the Republican Party since the Affordable Care Act became law. What’s different is Trump’s willingness to crow about the health care sabotage that has become his party’s trademark move.

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After Senate attempts to repeal at least some of the Affordable Care Act plan went up in a poof of gray exhaust last week Trump vowed to “Let Obamacare implode,” which means continue the sabotage of the ACA that has been one of his administration’s few accomplishments. Then the commander in grief tweeted a threat to withhold the “BAILOUTS for insurance companies,” referring to cost-sharing reduction payments that reimburse insurers for services to low-income Americans that have already been rendered.

Without those payments, insurance premiums in the individual market can be expected to rise by 15% to 21%, according to the Kaiser Family Foundation. And in exchange for these higher prices, the federal government — also known as “you” — would end up paying out billions more for coverage than is projected now, as the need for higher subsidies cancels out any benefit of stiffing insurers.

Trump’s ACA sabotage, while unconscionable and perhaps unconstitutional, is still a better deal than what 94% of Republican senators voted for last week. It was fortunate that three Republicans joined Democrats to block it. But the real miracle is that 49 Senate Republicans were willing to back a “skinny repeal” would have left 16 million uninsured in 2018 and increased premiums by 20% each year from 2018 to 2026.

This was a bill so deplorable that even many of the Republicans voting for it said they didn’t want it to become law, yet it contained no “poison pill” that would have prevented it from passing it on as is to Trump, who is desperate for anything he can call a victory.

You could credit that to Majority Leader Mitch McConnell’s mastery of the Senate. Or you could recognize that uninsuring Americans is the passion that has held together a GOP often on the verge of taking the leap from Civil War reenactors into a full-blown civil war.

Even the most conservative members of the House can’t openly admit to wanting to watch Obamacare “implode,” knowing they’ll own the implosion. But when Republicans whine about Obamacare’s failings, they are really taking credit for an extraordinary successful effort to sabotage it. 

There are as many as 4.8 million Americans who would have Medicaid coverage today with almost no out-of-pocket costs — most of them in Texas, Florida and Georgia — if Republicans in their legislatures and/or the governor’s mansions weren’t blocking the law's optional expansion.

Reports about insurers fleeing the marketplaces rarely mention that this phenomenon is most common, and mostly unique to, red states that have purposely sabotaged their online insurance exchanges. Brian Dew and Dean Baker found “almost 20 times as many people with no choice of insurers in the exchange in states with Republican governors as in states other than North Carolina that have Democratic governors.”

The parody of a process that regurgitated Trumpcare has revealed that the GOP’s Obamacare resistance wasn’t a principled opposition to anything — except to the man who signed the ACA into law, and the taxes on the rich and corporations that make Obamacare possible.

The GOP had most of a decade to chew on a plan to replace Obamacare, and the cud the party spit up to replace it would have left between 16 million and 32 million more Americans without any health coverage.

I have a Cadillac health insurance plan in a land of jalopies. How is that fair?

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A federal court has now intervened to allow Democratic attorneys general to fight for the cost-sharing reduction payments. And the chairman of the Senate’s key health committee, Tennessee Republican Lamar Alexander, is calling on Trump to make the payments through 2018 (perhaps realizing the president is actually blackmailing Republicans, who’d have to deal with an exploding insurance market right before the  2018 midterm elections).

But the fact remains that uninsuring Americans or "Leaving Americans without insurance" is more than just a threat from Trump. It’s still many Republicans' No. 1 priority. This latest defeat is only a delay. The only way to stop the government from coming for your insurance is to defeat them.

Jason Sattler, a member of USA TODAY's Board of Contributors, is a columnist for The National Memo. Follow him on Twitter @LOLGOP.

You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @USATOpinion and in our daily Opinion newsletter. To respond to a column, submit a comment to letters@usatoday.com.

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