Former Obama administration officials Gene Sperling and Chris Jennings have a primer on the various ways the Trump regime can work to undermine Obamacare and how to determine if he's laying the groundwork for destroying it from within. The problem for Trump, they argue, is that if he is "seen as purposely seeking to destroy the ACA to try to make his claims come true, he will destroy the trust he needs for any chance at future bipartisan legislation." So he's going to need to be sneaky about it. If that's possible.
First off, they say to watch for what the regime does with the pending lawsuit House Republicans brought several years ago to halt federal subsidies to insurers to help lower-income individuals pay their deductibles and copays. Two powerful House Republicans now say that Congress should appropriate the money for those subsidies. The easier move—since passing anything to make Obamacare work is going to require Democratic votes—for House Speaker Paul Ryan and Trump would be to withdraw the suit. So Sperling and Jennings say that the "critical test for the president will be whether he can work with the Congress to move to withdraw the House's lawsuit and ensure ongoing funding for cost-sharing, and do so before the court-imposed deadline of May 22.
The second big question is whether Trump will enforce the individual mandate, the core of the law which requires everyone who can afford it to have insurance or pay a penalty.
Trump’s first executive order, though, asked for all parts of his government to “minimize the burdens” of the ACA, which many feared could result in a refusal to enforce the individual mandate. […] So while Trump’s executive order did not by itself weaken the mandate, it did send a message that the tax penalties used to incentivize mandatory health coverage are not likely to be strictly enforced. The second major test to determine whether the President is choosing sabotage over governing will be if he directs his administration not to enforce the current individual-mandate provisions within the ACA.
Related to the mandate, the next thing to watch for is whether the Trump regime will make any attempt to encourage enrollment, or whether he'll discourage it. We saw the first attempt at discouraging enrollment when the regime tried to cancel the advertising the Obama administration already had in place for the last few weeks of open enrollment. "If the Trump administration declines to match the effort and resources the Obama administration dedicated (and, instead, substantially reduces them), it will be a clear indication that it is choosing sabotage over governing."
Here's another one for the insurance companies—will the regime make any effort to stabilize insurance markets which are still struggling thanks to Sen. "Little" Marco Rubio (R-FL) and his sneaky and successful efforts to limit the funding that was built into the Affordable Care Act to help plans adjust to the new markets. The funds were paid into by insurers and would help out plans that enrolled more expensive patients than they'd planned for. Rubio's interference has led to sharply declined payments and to lawsuits from insurance companies. So the question for Trump is if he'll do anything to restore those payment levels and stabilize the markets.
There are also the "thousand cuts" the regime could do that won't look like "the most blatant acts of sabotage." And there are plenty of them. Between that and how he chooses to use his bully pulpit, "whether Trump uses tweets, cell-phone calls, or White House meetings, investing time and political capital in to spur major health-care players to constructively participate in the ACA or conversely, to fear that if they do they will be on Trump’s black list," are the final two tests. One, watch for what Trump does and says, but two, watch for what all the stakeholder groups are saying.
If the overwhelming number of health experts and consumer groups like the National Association of Insurance Commissioners, Kaiser Family Foundation, the American Cancer Society, AARP, and the Georgetown University Center on Health Insurance Reforms conclude it is an attack on the stability of the ACA—it should raise [a] red flag that it is indeed a concerted effort to weaken the ACA.
Trump is so erratic that it's going to be hard to know exactly what his intentions are—he probably doesn't know them! You could look at his continually reiterated campaign promises that no one would lose coverage and that everyone would be taken care of and conclude that if he really doesn't want to see millions of people lose their health care on his watch. But at the same time, he was happy to throw them to the wolves it if meant he could get a "deal." The only thing that's sure right now is that the ride on Obamacare is going to continue to be bumpy.