This week, buried under the stories about Syria, Russia, Afghanistan, and a gentleman being brutally removed from an airplane, something quietly extraordinary happened. While interviewing with the Wall Street Journal, President Trump discussed the future of the Affordable Care Act in the wake of his party's stunning failure to repeal it last month. He suggested, almost casually, that he might order the payments to help those unable to afford insurance mandated by the law to be stopped as leverage to force Democrats to "negotiate" on repeal efforts.
Whether such an effort would pass muster for the inevitable court challenges is doubtful, so the practical effect of the policy is going to play second fiddle in this analysis. It should be noted, however, that under portions of the law that would remain in place should Trump make that call, individuals would still be required to purhase insurance or pay a fine. The subsidies are what made this policy reasonable with regard to lower-income consumers who still did not qualify for Medicaid. Simply not paying the subsidies would force those consumers out of the insurance market, eliminating their access to most basic care, and fine them every tax season for their trouble. It is a very direct slap to the face of the lower-middle class.
What I would like to focus on, though, is the simple fact that Trump was willing to make the threat. The ACA repeal effort ultimately failed because a number of Republicans were unwilling to leave the people in their districts who need the subsidies to maintain insurance without any way to afford their coverage. It is not a small thing to take the ability to afford health insurance away from someone. That simple fact was enough to derail what had been the Republican Party's premier policy goal for seven years, even though they controlled the Presidency and both houses of Congress. Yet, the President of the United States is so very detached from the day to day concerns of actual people in this country that he is willing to discuss leaving several million people without the ability to afford health care as a pawn to get leverage over his political opposition.
It is said that politics is a game where anything goes. But that isn't entirely true. In a stable society, conventions and respect for how things are done restrain the lengths to which politicians are willing to go for success, as well as the lengths to which the people will tolerate them going. Our political system was set up with the express intent of limiting personal authority and the ability-to-get-ones-own-way as the driving force behind policy. Trump, it seems, has absoluely no personal problem with holding several million people hostage to force the opposition to do as he pleases. That is a problem.
It will be remembered that Trump acceded to the presidency on the back of his claims to work for "the people" and to buck the entire political establishment. The efficacy of that rhetoric is undeniable. What his threat shows vividly is that concern for those people is at most residual for Trump. Even someone who is vehemently opposed to the form of the ACA would recognize that it is immoral to purposefully keep funds from people who need them to afford insurance when they are still mandated to buy it. For the president that concern is overruled by the prospect of acquiring a personal advantage over those who don't like him.
I have said before in this forum, and I truly believe, that what really matters to Trump is Trump. At no point in his presidency to date has that been more apparent. His first major legislative push was an abject failure. Instead of moving on to the next priority, or even considering a different approach to break the stalemate on his signature issue, this is the path he chose to propose; a spiteful suggestion to directly hurt people in an attempt to get his opponents to cave.
His actual words were "I don't want people to get hurt." It would seem that if he didn't want people to get hurt the obvious thing to do would be not to hurt them. But what he said isn't precisely what he meant. He meant his words in the same way a mafia boss would mean them. He isn't saying that he doesn't want bad things to happen to anyone, he's saying that he will make them happen if he doesn't get his way. Maybe in this case he won't follow through on the threat. Maybe he never will. But the unavoidable fact remains that we have a president who thinks in that way. The problems of individual people are just a bargaining chip in his plan to get what he wants.
That makes him different in a fundamental way from even the morally worst individuals who nonetheless feel constrained in public to abide by the rules of decency. We should not be surprised if this approach appears again, on some other issue on some other day, to blackmail his opposition. He may have been legally elected, and he may not yet have committed a technically impeachable offense, but behavior like this makes it more clear every day that Donald Trump is personally unworthy of the office he holds.
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