With Republicans unable to advance a health care bill in Congress, President Donald Trump’s administration may find itself in an awkward role as caretaker of the Affordable Care Act, which he still promises to repeal and replace.
The Constitution says presidents “shall take care that the laws be faithfully executed.” So as long as former President Barack Obama’s law is on the books, that doesn’t seem to leave much choice for Trump, even if he considers the law to be “a disaster.”
“It’s either caretaker or undertaker,” quipped economist Joe Antos of the business-oriented American Enterprise Institute. “I think in the end it’s going to be ‘caretaker’ because they’ll finally realize nobody is going to blame Obama. Having the thing blow up is going to be considered in the public eye to be Trump’s fault.”
Every move by Trump’s health chief will be scrutinized by Democrats for evidence of “sabotage,” a charge they’re already making. Meanwhile, the administration will try to use its rule-making power to bend Obama’s law toward Republican priorities.
The Trump administration’s first sign-up season, for 2018 coverage, starts in about three months, on Nov. 1.
Some things to watch for:
Consumer organizations, state officials, Democrats, insurers, and groups representing various health care interests will keep close tabs on the actions of Health and Human Services Secretary Tom Price and his deputy, Seema Verma, who runs the federal agency that administers health insurance programs.
Intimately familiar with HealthCare.gov, former Obama administration officials will be looking over the shoulders of the Trump team — Twitter accounts at the ready.
“We are going to hold HHS accountable to fully implement the law,” said lawyer Mara Youdelman, who heads the Washington office of the National Health Law Program, an advocacy group. “The Affordable Care Act is the law of the land, and everyone who is working for the administration should be committed to upholding the law of the land.”
Price so far has sent mixed signals. His department recently canceled contracts for community groups to provide sign-up assistance in 18 cities. His official rhetoric about the law has been harsh, maximizing its faults without recognizing the health benefits of 20 million more people with insurance.
But the department did work with Alaska on a waiver that’s been praised for helping to stabilize that state’s insurance market. And early on, the agency…