July 30, 2017 09:51 AM UTC

Trump Basically Threatens To Kill The Poor

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• by: Colorado Pols

MONDAY UPDATE: Some clarification about what President Donald Trump may be referring to in his vague threats to cut off “bailouts.” There are two kinds of subsidy payments made by the federal government to reduce costs to patients, what’s known as Advanced Premium Tax Credits, which directly offset premium costs, and Cost Sharing Reduction Subsidies. Trump’s Twitter threats appear to target the cost-sharing reduction subsidies, which help low-income patients on “silver” plans cover copays and out-of-pocket responsibilities. As the letter below from insurers and the American Medical Association makes clear, the effect on poor patients from cutting off the CSR subsidies would still be extremely serious, as “a tremendous number of Americans will simply go without coverage and move to the ranks of the uninsured.”

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As the Los Angeles Times reports–how can you call this government? There are other words that apply:

Frustrated by the failure of the Obamacare repeal in the Senate, President Trump on Saturday threatened to end federal subsidies for healthcare insurance — for Congress as well as the rest of the country…

“If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” Trump tweeted, fuming about Congress’ failure to repeal the Affordable Care Act, which he said was “imploding.”

Such a move could cause havoc and much higher premiums in insurance markets, since many low- and moderate-income people depend on those subsidies to help cover the cost of their policies. Through a series of administrative maneuvers by Congress and the Obama administration, members and their staffs also benefit from those subsidies.

…Trump’s longstanding threat to let the health insurance plans fail would come with its own political price. The federal government sends about $600 million a month to insurance companies to help cover the cost, and Trump is threatening to cut that off to allow Obamacare markets to collapse. [Pols emphasis]

To simply cut off the subsides that have been helping millions of Americans afford private health coverage would be severely disruptive to much more than the health care markets. The cost in individual human terms would be immense as patients suddenly found themselves faced with unaffordable out-of-pocket costs, and in many cases disruption of health care treatments they are undergoing at the time.

The American Medical Association, all the major health insurers, and the Federation of American Hospitals laid out the stark consequences in a letter earlier this year to Senate leadership:

Millions of Americans do not receive health insurance through an employer, Medicare or Medicaid. The individual market is their only option for getting coverage. Unless CSRs are funded, a tremendous number of Americans will simply go without coverage and move to the ranks of the uninsured. This threatens not just their own health and financial stability, but also the economic stability of their communities… [Pols emphasis]

Simply put, continued uncertainty, particularly the lack of clarity around CSR payments, has led several insurers to conclude that they cannot participate for 2018. Those who will participate are responding to the market uncertainty with premium requests that are as much as 60 percent higher than last year.

That’s a nice way of say that such a move would kill people. Not in some remote sense, insulated by layers of process and bureaucracy. We’re talking about killing people in some of the most direct terms possible without actually lining them up and shooting them. The idea that Donald Trump, the President of the United States, would threaten something so plainly harmful to millions of Americans seems like it should be unthinkable.

Except it isn’t. He’s really threatening to do this.

However you feel about the 2010 Affordable Care Act, whether you support it or oppose it, you cannot deny that it exists today–and that millions of Americans depend on it for their health coverage. Repealing the ACA would have negative effects far beyond the Americans who get subsidy help to pay their expenses, but they are the ones who will be made to suffer first if Trump makes good on this threat to cut these subsidies off. The rest of us will feel the effects secondarily as the entire health care system absorbs the shock.

Even if you want Obamacare repealed, how can anyone in good conscience support something like this? It’s not a rhetorical question, since there is a percentage of automatic support for anything Trump says, and beyond that no small number of hard-right ideologues who wouldn’t mind a little human suffering to “teach liberals a lesson.”

But you people out there with a shred of decency left in you. What about you?