Donald Trump

Since Donald Trump was defeated in the 2020 Presidential election, most people seemed to be under the impression that the Republican Party's decade-long obsession with tearing down President Obama's signature legislative accomplishment, the Patient Protection & Affordable Care Act, was finally over.

Healthcare journalist extraordinaire Jonathan Cohn even pulled the trigger on publishing his definitive history of the ACA, The Ten Year War...although honestly, there was still one remaining major legal loose end to tie up which wouldn't happen until about eight months later.

Obamacare Logo

The 2024 ACA Open Enrollment Period is going on right now and will continue through January 16th in most states. So far, I've confirmed that over 4.7 million Americans have enrolled in either ACA exchange Qualified Health Plan (QHP) policies nationally or Basic Health Plan (BHP) policies in New York & Minnesota specifically; the odd are that the combined total will be over 18.5 million by the time the dust settles in January.

"The Democrats are the party that says government will make you smarter, taller, richer, and remove the crabgrass on your lawn. The Republicans are the party that says government doesn't work and then they get elected and prove it." --P.J. O'Rourke, Parliment of Whores

As I noted on Friday, Donald Trump's executive order essentially orders the incoming HHS Secretary (presumably Tom Price), along with other relevant agency heads, to do everything in their power to sabotage the ACA regardless of any repeal legislation (whether partial or total) on the part of Congress. Since the ACA grants the HHS Secretary pretty wide authority about how (and whether) to enforce various components of the law, this gives ample room for the Trump administration to make the individual mandate (among other ACA provisions) effectively meaningless.

(note: too many updates in too short a period for me to even keep track of...)

At first, most healthcare reporters thought this was a fairly meaningless "mission statement" without much impact...

Trump also issued a memo to all agencies requesting that they begin to "ease the burden of Obamacare as we transition from repeal to replace," Spicer said. He declined to provide specifics on what various agencies might do in response to the president's directive.

HOWEVER, David Anderson (formerly Richard Mayhew) notes that Section 2, which instructs the HHS Secretary to "waive, defer, grant exemptions from or delay" any "fiscal burdens" o sounds an awful lot like telling them to be absurdly lenient regarding granting "hardship exemptions" from the individual mandate:

@annaedney @ZTracer yes individual mandate exemptions will be passed out like pacifiers at a rave

— David Anderson (@bjdickmayhew) January 21, 2017

Me, November 15th:

IMPORTANT: I cannot guarantee accurate federal data after 1/20/17.

...HOWEVER, their bosses...the HHS Secretary and, I presume, the head of CMS...will be appointed by Donald J. Trump and confirmed by a 100% Republican-controlled Senate.

Given Trump's long, disturbing history of flat-out misstatements (aka "making sh*t up out of whole cloth"), and the type of sycophants he's likely to put into place, I can't guarantee with 100% certainty that the numbers spouted off by them are going to bear any connection with reality. Maybe they'll be accurate. Maybe they'll be off slightly. Maybe they'll be completely removed from any actual numbers. Who the hell knows?

Earlier today it was reported that Ben Carson was being considered for HHS Secretary. Then the rumor mill turned to Bobby Jindal. At the moment, I'm hearing it could be Rep. Tom Price, who (like pretty much every other GOP member of Congress) despises the ACA. That doesn't guarantee that he'll Make Sh*t Up, of course, but under a Trump regime, anything's possible. Anything.

Donald Trump on this morning's This Week with George Stephanopolous:

STEPHANOPOULOS: You say that Ted Cruz is a liar, but you have said that you want everyone to be covered on health care and the government is going to pay for it. How is that not ObamaCare?

TRUMP: I want people takes -- that's true. I want people taken care of. I have a heart. I want people taken care of. If people have no money, we have to help people. But that doesn't mean single payer. It means we have to help people.

STEPHANOPOULOS: How do you do it?

TRUMP: We'll work something out. 

And...scene.

(OK, I admit I left out some of Trump's blather before/after; feel free to click the link for his "fully detailed" response).

Advertisement