Andy Slavitt

Opinion columnist

President Trump isn't afraid to use his bully pulpit, or become an outright bully, to let us know what's important to him. We don’t see moral leadership – quite the contrary. Instead he revels in mocking senators, NFL football players, public officials in disaster zones, morning TV hosts, and news outlets that bring him bad publicity.

In health care, his priorities are equally clear. He wanted repeal of the Affordable Care Act so badly he couldn't hide his disappointment and contempt for those in Congress who couldn't put a bill on his desk. Other than political validation for him and the rejection of Barack Obama's policies, who knows what health care issues he cares deeply about?

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Trump made it clear he would sign any bill that got to his desk, so long as he could call it repeal and replace. When no bill arrived, he made two major moves last Thursday to initiate what I call a Synthetic Repeal of the ACA and usher in the Trumpcare era. He signed an executive order that sows the seeds for driving up costs and limiting coverage. And he jolted the system by halting payments to insurers that are intended to lower premiums and deductibles.

Trumpcare is the result not of a thoughtful process, but nine months of tearing down every element of the law he could possibly touch — from outreach to marketing support to state innovation to, now, the very fabric of how insurance markets work. Strenuous objections are coming from patient groups, physicians and hospitals.

The American Academy of Actuaries, no political hacks, says his executive order will lead to higher costs for American families, solvency concerns for insurers, and reduced protections for consumers once they get sick. The non-partisan Congressional Budget Office has already told us the impact of his move to stop the “cost sharing reduction” payments to insurers — a near $200 billion increase in the deficit, 20% higher average insurance premiums and a million more Americans uninsured.

Taken together, these acts of economic and political defiance bring us Trumpcare. It’s vandalism pure and simple: destruction without regard to the lives impacted. And like the teenager, Trump will deny any of the blame when it shows up.

Lost in all of this, we also see what Trump doesn't value — children's health care in the form of the Children’s Health Insurance Program. It’s one of our country's last proud bipartisan achievements with near universal acclaim, but CHIP also has the unfortunate feature of being part of Hillary Clinton's legacy as first lady.

Trump and Senate Majority Leader Mitch McConnell decided last month that rather than renewing this program, which provides affordable insurance to 12% of the kids in the country and a large proportion of low-income kids, they’d try ACA repeal one last time. And so on Sept. 30, without so much as a tweet or remark from the White House, CHIP expired.

Last week, Trump bragged about his ability to dismantle the ACA by himself with "the power of the pen." But he failed to call on Congress to right this wrong and renew CHIP. Yet another reminder that we pay the price for the absence of moral leadership in the White House every day.

Meanwhile, Republicans in Congress continue to play games with CHIP and the 9 million kids it serves. The House has proposed a bill, but it’s one they know can't get through the Senate because it includes provisions that raise costs for people insured through Medicare and the ACA.

Another casualty of all of this is a further erosion of trust between political parties that have never been more divided. After a contentious ACA repeal fight, CHIP was considered an easy one — a step on the path back to finding common ground. Yet the partisan approach to CHIP has set the parties back further. In this day and age, rolling the minority takes precedence over simply doing the people's business.

And this is easy enough to do when the man with the bully pulpit is uninterested in taking notice. From the White House, there hasn't been so much as a tweet or public rebuke to tell his party to do its job and pass a long overdue health insurance bill for kids. This is not just thin skin. It's evidence of a moral vacuum.

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Trump sees this all coming to a head in December in a fight that he is badly miscalculating and could easily lead to a shutdown of the government. He craves a big deal to declare 2017 a success. So he is gathering hostages — the health of kids, a functioning insurance market, the status of Dreamers illegally brought to the U.S. as children by their undocumented parents. Trump's plan is to use these hostages to get Democrats to agree to have taxpayers pay for his border wall and other demands to please his base.

But Trump will find that Democrats have no reason to give in to morally bankrupt demands in exchange for partially fixing what Trump has destroyed. And so we are set to enter 2018 a divided and vandalized country, limping through the year and building towards a midterm election that may be our first best chance to reverse course.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt