If it’s not obvious why the Trump administration has decided to roll back regulations requiring employers to offer contraceptive coverage in their health plans: it’s the base, duh. This is little more than Trump paying off conservative Christians, who are among his strongest supporters. If you doubt this is what’s behind the new move, check out the language of the announcement:
The new rules allow any employer or insurer to stop covering contraceptive services if they have religious beliefs or moral convictions against covering birth control. It would be up to states to determine how companies should make these decisions.In a statement, the agency said “these rules will not affect over 99.9% of the 165 million women in the United States.” Senior Health and Human Services (HHS) officials said some large companies, including Pepsi and Exxon, had pre-ACA plans that will continue and not have to cover contraception. Some church groups were already exempt from the law and not providing this coverage.
Taking the administration at its word, then, this regulation is a cynical ploy more for show than any practical effect. If it won’t affect many consumers, why bother with it? It’s meaningless. The Obama administration already exempted religious organizations from this requirement—as anyone but the completely intransigent has long since realized—and the Supreme Court added “closely-held, for profit corporations” to the list. So even the most benign explanation is that Trump is playing to his base’s fears of cultural displacement, including the displacement of losing the ability to police women’s sexuality, without really doing much of anything.
What seems more likely (not taking the White House at its word) is that this is another in a long series of efforts by the president to undermine the ACA. Trump wants to drive as many companies and consumers out of ACA-compliant policies as he can, to spike rates and send the ACA into a “death spiral.” He’s willing to screw over even Republican governors to do that. Given that the new order leaves it up to the states to decide whether to grant conscience clause exemptions to the contraceptive mandate, it seems likely that Trump is willing to stick other governors with the cost of implementing his order.
Trump’s campaign to kill the ACA might work, but it will come at a terrible political cost, to himself and to his party. As Paul Waldman points out, the contraceptive mandate is quite popular, with nearly 70% approval in one poll, including a majority of Republicans. The ACA itself is somewhat less popular, but has been gaining strength ever since the GOP-led Congress started taking whacks at it with a fire axe earlier this year.
Which leaves the question: what the hell are they doing? This makes little political sense. Again, Waldman’s got the best explanation:
They’re doing all this after it has become clear they won’t be repealing the ACA any time soon. From a political standpoint it’s impossibly stupid, because it gives Democrats all kinds of ammunition to say that Trump and the Republicans are destroying your health care. A different Republican administration would grudgingly implement the ACA and look for conservative ways to allow states to improve their systems. The Trump administration, and Donald Trump personally, seem to want to make things as awful as they can for as many Americans as they can.If you’re a venomously anti-government Trump voter, this is great news. Screw all those lazy freeloaders who want to suckle on government’s teat and think they have a right to help affording health care! Take that, Obama! But if you care about whether the Republican Party is going to hold Congress and the White House, it’s a terrible idea.
“If you’re a certain kind of Trump voter, he’s coming through for you, bigly,” Waldman concludes. “At least for now.” That certainly goes for Trump’s conservative Christian base. Hilariously, while they and their supporters welcomed the news, the Little Sisters of the Poor—the chief religious antagonists of the contraceptive mandate—are continuing their Becket Fund-supported battle in the courts, where they’ve found far less friendly ears than in the Executive Office.
What happens when the ACLU, which has already announced that it will sue to block enforcement of the new regulations, carries the day, and the administration has to go back to the base empty-handed? Or worse, when they have to come up with some half-baked “compromise” after the president gets frustrated and abruptly changes course, revealing in the process he never really gave a damn about their “moral objections”? Whatever the short-term benefits, in the long run, this will more than likely turn out to be a spectacular failure, enraging liberal opponents and frustrating conservative supporters.
But that’s the price you pay when you set out to please your base without considering the long-term costs. Trump does seem to have concluded that he can’t survive without the conservative evangelicals and Catholics, and they have come to the same conclusion about him. We’ll see if this turns out to be a beautiful swan dive or an ugly confrontation with the concrete reality residing directly below the diving board. Place your bets, due in November 2018.