In his first address to a joint session of Congress, on February 28, President Donald Trump will outline his vision for strengthening the U.S. military, securing the nation’s borders, potentially overhauling the federal government’s budget, and replacing the Affordable Care Act (ACA). This will be a one-sided matchup between a president with record-setting productivity in his first six weeks and a Congress that has little to show after its first nine weeks, despite Republican control of the House, Senate, and White House.
Trump’s action against ACA to date qualifies him to scold congressional Republican leadership for failing to prepare adequately in the past eight years to replace Obamacare. Speaker of the House Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) have so far failed to definitively back any of the several replacement plans members of Congress have proposed.
Trump has yet to unveil specifics of his oft-promised Obamacare replacement plan, and he has sent mixed messages about what a replacement plan must include. Nevertheless, a tally of Trump’s actions against Obamacare speak louder than his words.
As early as November 29, 2016, then-President-elect Trump sounded the death knell for Obamacare by nominating then-Rep. Tom Price (R-GA) to lead the Department of Health and Human Services (HHS). Price had introduced legislation to repeal ACA in every session of Congress since it became law in 2010. The U.S. Senate confirmed Price 52–47 on February 9.
Another Obamacare slayer Trump tapped early on is Vice President Mike Pence, whose address at a Republican Governors Association conference one week after the election caused South Dakota Gov. Dennis Daugaard (R) to abandon his plans to expand Medicaid under ACA. In addition, Trump has nominated Seema Verma to lead the Centers for Medicare and Medicaid Services. Verma previously developed the Healthy Indiana Plan, possibly the least-flawed Medicaid expansion plan among the 32 states that extended the ACA health insurance entitlement to able-bodied adults with incomes above the federal poverty line.
Trump took aim at Obamacare within hours of taking the presidential oath of office on January 20. One of his first executive orders, titled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” instructed executive-branch departments and agencies to slow implementation of ACA as far as current law permits.
The greatest achievement of this order was underreported. The order emphasizes the executive branch is bound by the U.S. Constitution to implement laws passed by Congress, including laws the chief executive dislikes. Contrast Trump with former President Barack Obama, who gloated in 2014 that instead of “waiting for legislation” to arrive from Congress, “I’ve got a pen and I’ve got a phone.”
It’s ironic Trump chose to use his executive order regarding a law he loathes to signal that “in America, the law is king” (as Thomas Paine wrote in 1776). This is a better use of Obamacare, however, than Democrats or Republicans could have imagined. As I wrote at The Hill at the time, “Strict constructionists interpreting the Constitution according to the Framers’ original intent do not want a ‘Republican Obama’ who flouts bad laws. We want a Congress that replaces bad laws with good ones, and we want an executive responsive to but not controlled by Congress or the Supreme Court.”
Stemming directly from Trump’s Obamacare executive order, the Internal Revenue Service (IRS) canceled a rule the Obama administration had scheduled to apply to 2016 tax returns. Obama’s IRS would have rejected the tax returns of filers who failed or refused to check a box indicating they complied with ACA’s individual mandate, which requires individuals to buy insurance or pay a tax penalty.
Although Trump lacks authority to abolish the individual mandate and penalty, Trump’s IRS has made it easier for Americans to file their taxes. Simply put, Trump refuses to make tax returns and the patients filing them the hostages of Obamacare.
The new Congress’s indecision regarding ACA has relegated the legislative branch to a perversely responsive role. Instead of responding to the voters who elected them and Trump largely due to their promises to repeal Obamacare, congressional Republican leadership is forever responding to Trump.
Expect Trump to scold them for it, and watch them respond.
— Michael T. Hamilton (firstname.lastname@example.org, @MikeFreeMarket) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.
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