WASHINGTON — President Trump lit a fuse this week that will blow a hole in the Affordable Care Act, but the collateral damage could very well include fellow Republicans.
In his latest attack on the health care law, Trump moved Thursday night to eliminate payments to insurance companies that subsidized out-of-pocket medical costs for lower-income people.
Health care specialists predict this $7 billion cut will trigger a destabilizing cascade that will jeopardize health care access for millions of Americans, as insurance companies jack up premiums or pull out of the federal exchanges altogether.
The step also heightens the risk that Republicans will be blamed for higher costs and other market disruptions stemming from Trump’s administrative assaults on the health care law, which was President Barack Obama’s signature accomplishment.
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“Cutting health care subsidies will mean more uninsured in my district,” tweeted Florida GOP Representative Ileana Ros-Lehtinen. Trump “promised more access, affordable coverage. This does opposite.”
Polling indicates that Americans, including many Republicans, will indeed point the finger at the GOP. Sixty percent of Americans say they view Republicans as “responsible for problems’’ in the health law moving forward, according to an August survey by the nonprofit Kaiser Family Foundation.
Trump has already shrouded the health care program in uncertainty through a number of other recent measures. This week he said he will authorize interstate sale of lower-cost insurance policies with skimpier coverage, which will siphon off healthy people who don’t require a lot of medical treatment. That in turn will saddle the more robust plans with the sickest people, further driving up costs and premiums. Previously, Trump’s administration shrank the annual enrollment period for the exchanges and slashed advertising budgets.
In the face of congressional failure to pass a repeal-and-replace law, Trump can now claim to have tried through executive orders to fulfill a portion of his campaign promise to repeal the act known as Obamacare. Trump argued the subsidies to insurance companies were unconstitutional — echoing a 2014 House Republican lawsuit that sought their elimination — because they were never approved by Congress.
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He also said his actions may spur Congress to act.
“The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” Trump tweeted Friday morning.
Citing the potential for major upheaval, numerous Republican lawmakers had urged Trump for months to continue to making the subsidy payments. On Friday they warned of major damage to the GOP now that the president has ignored those calls.
“Barack Obama is no longer in the equation. This is on us,” Republican Representative Charlie Dent of Pennsylvania, who is retiring, said on CNN.
“It will be very destructive for the state of Nevada,” Republican Governor Brian Sandoval, an outspoken critic of congressional GOP efforts to repeal and replace the health care law, told the Nevada Independent. “It’s going to hurt people. It’s going to hurt kids. It’s going to hurt families. It’s going to hurt individuals. . . . It’s going to hurt everybody.”
Seventy-one percent of Americans want Trump and his administration to improve the current law and make it work, rather than undermine it, according to new polling from the Kaiser Family Foundation. Those feelings extend across the political spectrum: 74 percent of independents and 48 percent of self-identified Republicans want politicians to make the law work. By contrast, 43 percent of Republicans said they wanted the president to sabotage the ACA.
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Maine Republican Senator Susan Collins, who was among several lawmakers who thwarted attempts by Congress to repeal and replace the law this year, said she was “very concerned” about Trump’s moves this week.
Other Republicans Friday, including Representatives Leonard Lance of New Jersey and Carlos Curbelo of Florida, said Congress should move quickly to pass legislation to provide for the insurer payments, which the Department of Health and Human Services said Thursday would end immediately.
In the Senate, key Republicans have been working with Democrats on a bipartisan compromise on continuing the subsidies, which help pay out-of-pocket costs such as deductibles for lower-income Americans so they can actually afford health coverage.
But Trump’s budget chief, Mick Mulvaney, told Politico Friday that the president would consider such a deal only in return for Democratic concessions on other issues.
Trump sought to give his action a populist spin, telling reporters outside the White House that the payments help make health insurance companies rich by boosting their stock prices. “And that’s not what I’m about.” He said ending the payments should spur Democrats to work with him to make health insurance “good for everybody.”
Democrats say Trump is delusional if he believes canceling the insurer payments gives him negotiating leverage.
“Threats and bullying is not going to work” to bring Democrats to the table, said Senate minority leader Chuck Schumer on a conference call with reporters. “On this, politically, he’s in much worse shape than we are. The American people — even a large number of Republicans — are on our side in terms of improving the system, not destroying it.”
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Schumer predicted the two parties would strike a deal to restore the insurer payments by the end of the year, if not sooner.
Ending the insurer payments will result in premium spikes for middle-class consumers who make too much money to qualify for any sort of subsidies under the health care law, said Robert Laszewski, a health policy consultant.
“Ironically, it is these unsubsidized folks who have complained the loudest about Obamacare’s big premiums and deductibles. They will now have even more to complain about,” Laszewski said in his analysis.
Meanwhile, the nonpartisan Congressional Budget Office predicted that ending the insurer payments would add $194 billion to the federal deficit over 10 years.
The CBO said cutting off the money would trigger premium increases of 20 percent in 2018 — an election year in which Republicans will be trying to maintain their majorities in the House and Senate.
Craig Garthwaite, a Republican health economist at Northwestern University’s Kellogg School of Management, who sees plenty of flaws in the health care law, rejected the notion that this is a strategic ploy by the administration to force Congress back to the bargaining table.
“There’s no other way to interpret the timing of this other than sabotage,” he said, pointing to the last-minute timing, just before the start of enrollment Nov. 1, with no time for Congress to act. “I think we need to stop thinking about this administration as crazy as a fox and just admit that they’re crazy. . . . They lost on repeal and replace, they’re upset about it and their solution is we’re just going to destroy the market.”
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Astead W. Herndon of the Globe staff contributed to this report. Victoria McGrane can be reached at victoria.mcgrane@globe.com. Follow her on Twitter @vgmac.