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Apr 7, 2017

A warning from the polls about letting Obamacare "explode"

Drew Altman, Kaiser Family Foundation

President Trump has said the Democrats will take the fall politically if and when Obamacare "explodes." But new polling shows that the public will hold Trump and the GOP accountable for failing to address problems in the marketplaces, not the Democrats. That means they'll have to think twice about some of the moves they might make that could make the Affordable Care Act's problems worse.

Note: Neither of these/someone else is responsible, Both are equally responsible, and Don't know/Refused responses not shown; Data: Kaiser Family Foundation Health Tracking Poll (March 28 - April 3, 2017); Chart: Andrew Witherspoon / Axios
Note: Neither of these/someone else is responsible, Both are equally responsible, and Don't know/Refused responses not shown; Data: Kaiser Family Foundation Health Tracking Poll (March 28 - April 3, 2017); Chart: Andrew Witherspoon / Axios

What's on the line: The polling has direct implications for some of the specific actions Republicans could take, or not take, in the months ahead:

  • Eliminating the $7 billion in federal cost sharing subsidies to insurers to compensate them for providing smaller deductibles to lower income enrollees.
  • No longer enforcing the individual mandate that helps get younger, healthier people into the insurance pools to lower premium costs.
  • No longer marketing the healthcare.gov plans to boost enrollment.

These steps would cause insurers to exit the non-group market, cause premiums to spike, and could leave millions without affordable coverage.

As the chart from our latest tracking poll shows, 62% of the public say Trump and the Republicans in Congress are in charge of the government and are responsible for problems with the ACA from now on; just 31% say President Obama and the Democrats are responsible. As is always the case with the ACA, there are party differences; 81% of Democrats and 65% of Independents said Trump and the Republicans "own it", but just 35% of Republicans feel that way.

Trump has also said that the collapse of the ACA would bring Democrats to the table to forge a new "deal" with him on health care. That's not impossible, but it seems unlikely: it's hard to think of a single major element of health reform where the Democrats agree with the president and the Republicans.

As we saw when the Freedom Caucus refused to support the American Health Care Act because it wasn't conservative enough for them, the substance and the details matter to policymakers far more than they appear to the President. He has suggested that he mostly wants a deal on health care.

Basic rules of politics seem to be holding up pretty well in the fights over the ACA. One rule, that benefits once conferred on the American people cannot be taken away, was a primary reason for the collapse of the GOP health care plan. The other: If severe problems develop in the marketplaces, or are caused by actions the administration takes to undermine the law, the party in charge gets the blame.

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