Interestingly in a country where many debate the psychological state of this president, the American Psychological Association says Donald Trump is taking us backward in healthcare. Other critics are much, much harsher.

For much of the year, Trump has been upset that one of his signature campaign themes was not realized, the overturning of Obamacare. After all, for his base, his hard-core supporters, what had he done, beyond the mood swings? Every once in a while, in between tweets denouncing “false media” or criticizing the NFL, he took stabs at Congress for not passing a bill to rid the Affordable Care Act.

He wanted the wrecking ball and the GOP leadership didn’t come through.

Yesterday, he went off the legislative track and stayed on the executive: Trump signed an executive order to take steps that he says were designed to expand choices and alternatives to Obamacare, while increasing competition to reduce costs. Not so fast, critics say.  Trump also is moving to end billions of dollars of key so-called “cost-sharing” payments by insurers that help lower-income people pay for insurance, opponents say. The actions could undermine the entire Obamacare marketplace, and result in insurance policies with reduced benefits.

Many groups are concerned that the Trump action targets the most vulnerable: those people who need services the most may be left out in the cold. Some say that they are concerned that health plans ultimately would not provide the essential health services such as maternity care and services for children, and cheap and narrow plans would be structured outside of the Affordable Care Act  that might draw healthy people, but leave sicker people or those with pre-existing conditions facing what some term as “impossibly higher premiums.”

In a tweet this morning, Trump suggested he wants to work with Democrats on Obamacare. “The Democrats ObamaCare is imploding,” he wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!.”

“The time has come to give Americans the freedom to purchase health insurance across state lines, which will create a truly competitive national marketplace that will bring costs way down and provide for better care,” Trump said in an earlier statement.

Trump poked at the flaws of Obamacare: the percentage of workers at small firms receiving coverage through their employer had declined from nearly half in 2010 to about one-third in 2017, according to the White House.

The subsidies that Trump seeks to get rid of impact about 6 million people, the Department of Health and Human Services says, costing about $7 billion in 2017, according to CNN.

Once again, instead of trying to rebuild flaws in the current system, Trump seems intent on undoing it. He’s an interesting kind of developer. He destroys and then….His critics say with the executive action and others, healthcare in the country is becoming Trumpcare and the problems are his, at least politically.

“The executive order begins by reciting perceived failures of the Affordable Care Act; rising premiums for ACA coverage, reduced insurer participation in exchanges and reduced exchange enrollment,” Timothy Jost, a contributing editor at Health Affairs and emeritus professor at the Washington and Lee University School of Law, wrote in a Health Affairs blog. “However, many of the problems the individual market is experiencing are certainly due to actions the Trump administration has taken to undermine ACA coverage, and there is good evidence that the ACA market could have stabilized absent those actions,” Jost added.

The order essentially encourages health plans “to pick and choose” services they cover and won’t help those who desperately need mental health, substance use, and other critical services,” Antonio Punte, PhD, president of the American Psychological Association said in a statement. “Before the Affordable Care Act, more than one-third of individual market plan plans chose not to cover mental health services and nearly half chose not to cover substance abuse.”

Punte noted these are especially tough times: 91 Americans a day, for instance, are dying from opioid overdoses.

“Today health plans are competing on how efficiently and effectively they provide care, but the president’s executive order, if carried out, would take us backward by letting plans once again compete on how fewer services they cover and ignore state health insurance protections,” Punte said. “We are deeply disappointed that the administration continues to try to dismantle our health care system, instead of trying to increase enrollment and stabilize insurance markets.”

“Now that President Trump and the Republican Congress failed to end the Affordable Care Act by legislation, the president is sabotaging the law by executive action,” said Vanita Gupta, president and CEO of The Leadership Conference on Civil & Human Rights. “Today’s move is their effort to put another nail in the coffin. This order will only drive up costs for the sick and put the health of millions at risk.”

Trump’s executive order “will result in fewer protections for the most vulnerable Americans, such as those with pre-existing conditions, and will encourage sham, loosely regulated health insurance plans that won’t provide adequate benefits,” said Randi Weingarten, head of the American Federation of Teachers in a statement. “Ultimately, this could lead to the collapse of individual health insurance markets through which millions of Americans obtain coverage.”

“Donald Trump owns the unwinding of the Affordable Care Act,” Weingarten said. “He is ignoring the rule of law, refusing to compromise, and doing an end-run around Congress in order to strip people of their healthcare. Millions of Americans will be worse off because of his actions. There is an ongoing pattern of the Trump administration’s callous sabotage of Obamacare, and it will cause real harm to American families.” – Joe Cantlupe