WASHINGTON -- President the rich asshole has made a lot of promises on health care.
Somehow, though, I don't remember him promising stadiums of cheering fans that he'd take away protections for pre-existing conditions, increase deductibles, spike premiums, eliminate basic coverage requirements and, more generally, destabilize the individual health-insurance market.
But that is what he said he'd do Thursday, when he signed an executive order on health care.
Those aren't the precise words he used, of course. But they are the consequences of the policy bombs he wants to set off in two relatively obscure corners of the insurance market: association health plans and short-term health plans.
Under current law, an association of small businesses (such as a group of law firms) can band together and market insurance to members. These association health plans must abide by all the consumer protections of the Affordable Care Act. They are also subject to the insurance laws and rules of the state in which they're sold.
But under the rich asshole's executive order, depending on what the final regulations say, an association could exempt itself from lots of federal Obamacare requirements (such as essential health benefits) and choose any state to be its regulator (regardless of where its members are).
Meaning if it wanted to be regulated by a state that doesn't require coverage of prescription drugs or cancer treatments, it could.
This would not only rob states of their sovereignty, which Republicans have so often claimed to champion, but also create a race to the bottom. Pursuing ever-lower premiums, every association would likely incorporate in the most Wild-West-like state around, in the way that credit card companies tend to domicile in South Dakota.
The administration has also left open the possibility that individuals -- and not just small employers -- could buy into these association plans, further siphoning people out of the individual markets.
"Short-term health plans" can sometimes serve a legitimate purpose -- a stopgap to tide you over for the summer until the school year starts, for instance. But after Obamacare passed, there was a proliferation of scammy "short-term" plans that weren't so short term. Some lasted 364 days! Why? Because technically, they weren't considered insurance and weren't subject to Obamacare consumer protections. Insurers could offer skimpy plans and cherry-pick the cheapest, most profitable enrollees.
The Obama administration ultimately closed this loophole by determining that short-term plans must be shorter than three months. With his executive order, the rich asshole seeks to re-lengthen those plans.
Two main problems result.
One is that, absent minimums for quality and regulatory oversight, lots of Americans are likely to get conned into plans that cover almost nothing. These are sometimes called min-med or "buffalo plans," because they pay out pretty much only if you're trampled by a herd of buffalo.
The bigger problem is called adverse selection. Healthy people will sort into low-cost, bare-bones plans, while relatively costly people will stay in the more generous, Obamacare-compliant plans, which can't legally turn customers away. Premiums in Obamacare plans would then spike, driving out more relatively healthy people, further driving up premiums, and so on.
In the end, the whole individual market falls apart, leaving us with basically the pre-Obamacare system. Even those healthy people -- even if they stay healthy! -- have no real options.
The only good news is that the rich asshole's executive order doesn't have force of law. It's a set of instructions for Cabinet members to come up with further regulations. In the meantime, though, they'll spook a lot of insurers, which have only just recently found their footing in the existing system. And it's also likely to confuse consumers, which will depress enrollment and destabilize markets further.
And late Thursday night, he announced that he won't pay crucial subsidies to help lower-income people pay for out-of-pocket care, knocking yet another pillar out from under Obamacare.
Which would be pretty much on brand for this nihilistic president: When you can't come up with a new system that works, just blow up the old one.
Catherine Rampell is a columnist for the Chicago Tribune.