The departure of HHS Secretary and long-time Affordable Care Act foe Tom Price won't even slow down the Trump administration's efforts to sabotage the law. That's because this is Trump's mission, destroying the hallmark achievement of President Obama and it's entirely personal. Case in point, Iowa's.

For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application.

Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no. […]



It was a Wall Street Journal article about Iowa’s request that provoked Trump’s ire, according to an individual briefed on the exchange. The story detailed how officials had just submitted the application for a Section 1332 waiver — a provision that allows states to adjust how they are implementing the ACA as long as they can prove it would not translate into lost or less-affordable coverage.



Iowa’s aim was to foster more competition and better prices. The story said other states hoping to stabilize their situations were watching closely.


Some administration officials and staff in the Centers for Medicare and Medicaid Services are apparently still trying to get CMS to approve the waiver, despite Trump's direct intervention. That might be because Iowa is a red state. Or maybe they believe the state's insurance commissioner Doug Ommen, who warns "that over 20,000 middle class farmers, early retirees and self-employed Iowans will likely either go uninsured or leave Iowa," if the waiver isn't approved and the state allowed to stabilize its market. A HHS spokesman confirmed to the Post that "Iowa’s application 'has been deemed complete and is currently under review' but did not address the president's directive on the matter." And in case you're wondering, no, this is not normal. Presidents don't usually way in on these kinds of administrative decisions unless they are very weighty, and don't do so on the basis of no more information than a newspaper story.

Trump's punishment of states is indiscriminate here—red, blue, and purple states are all being punished. Oklahoma had a waiver pending for so long that it had to withdraw the request "after months of development, negotiation, and near daily communication over the past six weeks." In Minnesota, the administration did grant a waiver, but it came with a severe penalty. It gave the state $323 million for a reinsurance program—a guarantee to insurers that there will be funds available to back them up in the event they end up with customers with particularly high medical costs. That $323 million was given, but $369 million in subsidy funding for lower-income people was taken away from the state.

That's just one facet of the sabotage Trump is directing to destroy the law. From refusing to give insurance companies the assurance that the administration will keep cost-sharing reimbursements flowing—as required by law—to refusing to fund outreach to get new enrollments to using taxpayer money intended to advertise for Obamacare to run a public relations campaign to sabotage it.

Which ultimately means pain for a lot of people. It's an indiscriminate slash and burn strategy stemming from the racist, irrational hatred burning in Trump's heart.