EDITORIAL: Trump undermines his own party by cruelly sabotaging Affordable Care Act

Oct. 17--By scrawling his name a couple of times on Thursday, President Donald Trump added $194 billion to the deficit projection. He increased health care premiums for 12 million working poor and middle-class families by 20 percent and made health insurance unaffordable for 1 million of them. He further undermined the health care marketplaces and legalized cheap, bare-bones insurance sold across state lines.

With two executive orders, Trump made the private insurance side of the Affordable Care Act -- the part designed for working people -- more likely to collapse. Trump would have been smart to recall the Pottery Barn Rule that then-Secretary of State Colin Powell applied to the 2003 Iraq invasion: "You break it, you own it."

There is little evidence that Trump gave much thought to Obamacare until he decided to run for president in 2015 and realized the Republican base didn't like it, whereupon bashing it became a sure-fire applause line.

He has demonstrated almost no grasp of health care policy: "Nobody knew that health care could be so complicated," he famously told a roomful of governors in February, all of whom knew how complicated it was. Though he promised to replace Obamacare with "something great" at lower cost, he never put forth any ideas.

He took to his Twitter account Saturday morning to chortle that insurance company stocks had been pounded by his decision to stop making cost-sharing reduction payments that lower deductibles and out-of-pocket costs for about 7 million of the 12 million low-income people who bought ACA policies on health care exchanges.

Trump apparently failed to realize that those 7 million people will now qualify for higher tax credits from the federal government. The Congressional Budget Office estimates that added credits will add $194 billion to the deficit by 2028.

Many insurers, anticipating Trump's actions, already had programmed a 20 percent increase into next year's premiums. But some may abandon the marketplaces altogether. The administration already had moved to sabotage enrollment for 2018 by cutting the sign-up period that begins Nov. 1 to 45 days from 90 and drastically whacking the budget for client outreach.

The other executive order Trump signed Monday -- against the advice of state insurance commissioners and health care organizations -- allows small employers to join insurance associations, which offer cut-rate policies. They wouldn't have to cover a full set of benefits or preexisting conditions. Such catastrophic policies might lure healthy people out of the Obamacare marketplaces, further destabilizing them.

Congress can fix what Trump has torn asunder. Republicans should bear in mind that, according to a Kaiser Health Foundation survey in August, Americans by a more than 2-to-1 ratio hold them responsible for the Affordable Care Act's fate. Trump has tied a giant millstone around their necks just in time for election year.

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