It Just Will Not Stop

Just when one thinks that just about everything that could happen under the Trump Administration has already occurred — it can’t possibly get any crazier, but it does.  Last week was chock full of newsworthy items, any one of which would have been worthy of discussion but they just kept coming and coming. Over the last week or so, we’ve seen proof that President Trump still does not understand the dignity and impact of the presidency.

To quickly cover a few of the highlights before getting to the main event — health care bills — let’s do a tour d’ horizon.  Two venerable institutions, the Boy Scouts of America and Police Departments across the country, had to issue apologies and “clarifications” following President Trump’s speeches to the annual Boy Scout Jamboree in West Virginia and to a Long Island New York police department.

In the former he gave a political speech that was short on inspiration to America’s youth and long on past grievances, politics, and a reminder of how personally great everything Trump is and will be. Some parents threatened to pull their kids from the Scouts.  President Trump supporters opined that the “kids loved it” forgetting that they are boys and teens and that when you get 40,000 kids together in one place, especially mostly boys, they will laugh and cheer at just about anything, especially if flatulence is involved. On Long Island the president seemed to say that police brutality when arresting suspects was okay.  As usual, whenever called out on similar pronouncements, it was proposed that it was a “joke.” Police departments around the country could only cringe and issue statements that such statements were no joking matter and that their (fill in the city) police department does not condone such action.

Within days of President Trump announcing the new White House Communications Director Anthony Scaramucci, aka “The Mooch”, aka “Mini-me” Mr. Scaramucci went on a rant to a New Yorker Magazine reporter that disparaged key senior members of the White House staff and included numerous references, in full graphic detail, to acts of biology that to my knowledge are impossible.  No comment from the president at the time.  Others in the Administration opined that he’s just a “New Yorker” and apparently that’s how New Yorkers talk about co-workers.  Having lived for a number of years in New York state I don’t recall anyone talking that way and certainly not in the name of the President of the United States.

In Tweets (Tweets!) the president continues to disparage his own Attorney General and his first and for a very long time, only official supporter for president.  According to some accounts this is a prelude to cleaning out the senior levels of the Department of Justice including the Attorney General, his deputy, the Acting FBI Director, and Special Counsel Robert Mueller.  No problem there.  In another Tweet the president arbitrarily told all active duty transgender military personnel that their services were no longer required “in any capacity” because they are a burden and “disruptive.”  Suddenly somewhere around 7,000 soldiers, Marines, Sailors and airmen are in limbo and told that somehow their patriotism and willingness to defend the nation does not count.

In yet another Tweet, the president fired his chief of staff Reince Priebus.  The Tweet announced that retired Marine general and serving Secretary of Homeland Security John Kelly would be the new chief.

Whew!  A full week.

On the upside for those of us rooting for a successful and appropriate presidency there were several positive developments.  As I write this, reports are that Anthony Scaramucci was removed from his job of ten days as the Communications Director.  I have no inside information but I suspect that the new chief of staff had something to do with that as Mr. Scaramucci bragged last week that he only reported directly to the president and did not have to answer to anyone else on the staff.  My knowledge of General Kelly, although limited, would indicate that he would absolutely not tolerate antics such as those of Mr. Scaramucci.  Perhaps the General can bring order to the White House staff.  We’ll see, but a good first step.

Also positive, the Chairman of the Joint Chiefs of Staff General Joseph Dunford, USMC let it be known that the military does not act on Tweets or any other form of informal communications when a policy decision is to be made, even a Tweet by the president concerning transgender policy.  Hurrah. It remains to be seen what actual policy evolves, but it is good to know that spontaneous utterances by the president will not precipitate military action.

Further good news came out of the Congress that overwhelmingly passed a bipartisan bill strengthening sanctions primarily against Russia, but with some additional provisions against Iran and North Korea. The Congress felt it necessary after listening to, and observing the actions of, President Trump with regards to Russian President Putin and our president’s apparent fascination with him.  The White House staff had worked hard behind the scenes to stop the passage of the bill but both houses of the Congress got up on their hind legs and said “no” to the president on this issue. A positive sign that they may increasingly exercise their role in governing as an equal branch of the government.

Many Republican Senators and Representatives also went on the record along with their Democrat colleagues to oppose President Trump’s Tweet policy on transgender individuals in the military and the treatment of Attorney General Sessions.  Clear signs that the president will not get blanket support from them.  As an aside, the president now taunts Republicans as well as Democrats via Twitter seeming to make it clear that he does not consider himself a Republican.  But to most of us, that is no surprise.

And of course let’s not forget that North Korea tested new Intercontinental Ballistic Missiles (ICBMs) that experts think can reach targets on the U.S. mainland as far as Chicago.

Arguably the biggest news of the week was the failure to repeal or repeal and replace or otherwise get rid of the Affordable Care Act (ACA) lovingly known as Obamacare.  Most of us followed the news and at least heard of the ins and outs of the entire suspense filled week of “will they or won’t they?”  They did not.  One could ask why after seven years of clamoring for (and voting over 50 times for) the repeal of Obamacare the Republicans were not ready to put forward their own coherent health plan. One could also ask why the only argument put forward by most Republicans, and especially by the president, had nothing to do with the merits of the proposed replacement plan(s) but rather the only argument was that Obamacare was “bad” — nothing about why the new plan would be better.  SAD!

But be careful.

I do not think the health care battle is finished, only in a strategic pause.  There will be further efforts to repeal or repeal and replace.  For supporters of Obamacare, or supporters of a bipartisan effort to repair Obamacare and to make it better, do not relax.  The fat lady has yet to sing.

Over the weekend President Trump tweeted out (how else?) that Obamacare was going to implode and implicitly that he would make it happen.  On Sunday the Director of the Office of Management and Budget (OMB) Mick Mulvaney went on television to be explicit about the president’s threats/promises. As I have written in this space before, the president can do grave harm to the current Obamacare system, primarily through non-enforcement of the mandate and by withholding funds to subsidize premiums. He also made news by threatening the Congress and Congressional staffers with actions to increase their premiums.  I am no expert in this area, but this is what I understand is the issue.

Is it possible for the president to make Obamacare “implode” as he promises?  As with most things, the answer is “it depends” on what part of Obamacare one refers to during the discussion.  Since Obamacare remains the law of the land, the president cannot make it go away at once.  He can, however, create enough chaos in the system that it can degrade over time.  Remember that most Americans get their health insurance through their employers or through the government (military, VA, military retirees, Medicare, etc.).  For middle to low-income working adults and for children that do not have employer or government health insurance they mostly get their insurance through Medicaid or in a market place created by the ACA.  Although a major factor in the latest debates, Medicaid is provided by law and cannot be legally changed without a change to the law. What is really under discussion are the ACA market places.  Since the ACA was fully implemented, about 10 million Americans get their coverage via the government market place.  These are the people you most hear about on the news and in political rallies, be it how bad the system is or how wonderful the system is.

The administration has a number of ways to degrade the ACA.  In a slow motion effort, they could stop advertising and marketing the exchanges so that people either don’t know that the markets still exist (a lot of Americans are unsure as to what is available after all the latest hubbub) or miss deadlines to sign up because there was no public advertising as to how or when to get on board.  Additionally, if the administration follows through by not enforcing the mandate (either get insurance or pay a fine) healthy people will get out of the market which causes costs to rise for the insurers which is then passed on to those still in the market — their premiums rise — or the insurer gets out of the market because it isn’t profitable for them if they have to eat the added costs.  (Remember the three legs from my 23 June post. To work, if we want to cover pre-existing conditions, the system needs a mandate to keep the pool costs low by balancing healthy folks with those that we already know have problems, but then to be fair, we subsidize those that have to have insurance but cannot afford it.  Get anything out of whack, and the system starts to wobble — the promised “death spiral.”)

President Trump is threatening/promising to speed up the process by withholding cost sharing payments. As I write, they are only released through the end of July — today. (The next deadline is in late August.)  The ACA requires insurance companies to hold down the deductibles, co-pays and premiums for those in the individual market place. However, the insurance companies are not charitable organizations and they are in business to make money.  To make up the loss of revenue to those companies every month the government makes up the difference on the costs — currently about $600 million a month.  Should the Trump administration stop paying those subsidies, premiums for those on the market place would sky-rocket or the insurers would just pull out of the market.  This is a lot of what you hear about when those that oppose the ACA say it is “collapsing.”  Health care and health insurance is not “collapsing” for most Americans, but it could for those middle to low-income Americans that are on the individual markets should the president follow through and try to cause the ACA to “implode”.

He claims the Democrats will “own it” and he will take no blame.  I think he is fooling himself if he takes deliberate action to make it tough on the citizens he swore to protect.

There is one more esoteric wrinkle in the president’s threats that you may hear more about this week. Mr. Mulvaney explained the issue and says that the president is serious about implementing it.  This involves the health insurance for members of Congress and their staffs.  Despite rumors to the contrary, by law the entire Congress and their staffs are on the ACA — they get their insurance from Obamacare. But with a wrinkle.  President Obama’s administration put out a policy that allowed them to treat each individual office of each Senator and Representative each as a small business.  This means that they are eligible for the subsidies just talked about above, saving them lots of money out of their own pockets. Before setting our hair on fire, take a minute to think about it.  Certainly the individual Senators and Representatives could afford to pay full price in an employer plan, but most staffers, interns, administrative personnel, etc. working in their offices are young folks not making much money.  It would have a huge impact on them should President Trump change the policy to exclude them from the subsidy program.

Today is the start of a new week.  Let’s hope it is a dull one.  We need to take a collective deep breath and take a few minutes to enjoy the summer.  And summers in official Washington D.C. are supposed to be dull.  Nothing going on.  If so, hold on to your hats come September.