Health Care Collapse Not a Viable Option for Congressional Republicans

WASHINGTON — Since Republicans failed in their effort to repeal the Affordable Care Act last week, President Donald Trump has returned to a familiar refrain, saying that the party should just let Obamacare fail. But GOP lawmakers on Capitol Hill say that is not a viable — or politically prudent — option, because the party has plenty to lose if the law collapses.

Trump says that Democrats will own Obamacare’s problems if the GOP does nothing. But most Republicans in Congress fear that they will be blamed if their constituents lose access to health care or if their costs skyrocket.

“I said from the beginning, ‘let Obamacare implode, and then do it,’” Trump said about reforming the system on Friday. “I turned out to be right. Let Obamacare implode.”

There are at least two ways that Trump can allow the Affordable Care Act to implode. He could cut off subsidies for low income Americans to help them pay for deductibles and copayments, something his administration has threatened for several months. Trump also advocates doing nothing to help the individual market in some areas where insurers have stopped providing coverage. The uncertainty surrounding that has played a part in insurance markets fleeing some markets.

Related: What’s going to Happen to Obamacare?

But many Republicans reject both of those scenarios, potentially pitting Trump against his own party.

Despite failing to pass legislation to reform the health care system so far, no GOP senator has said that they support doing nothing now.

“I don’t think we ought to let anything collapse. This isn’t about winning and losing,” said Sen. John Kennedy, R-La.

But it is about the impact on their constituents.

The areas where the individual markets are down to one, two or even zero insurance options are most often in rural parts of the country and in the South or Midwest. Those states and districts are places that voted for Trump or are represented by a Republican in Congress, making it politically risky for the GOP to just let Obamacare fail.

Republicans are already bracing for electoral repercussions should they not fulfill their campaign promise of repealing Obamacare, but now they are also aware of potential consequences for not providing better, affordable options for their voters.

For instance, all of South Carolina, Alabama and Wyoming have just one insurance option and all three are almost exclusively represented by Republicans in Congress.

And many other areas with limited insurance options are swing districts or states currently held by Republicans — including Nevada and Arizona — making them potential targets for Democrats in next year’s elections. Others are in swing areas represented by Democrats — like Missouri and West Virginia — making them potentially less vulnerable to GOP challengers.

Image: ACA Insurer Participation

Insurer participation on the Obamacare Marketplaces