The Republican controlled congress has tried and failed multiple times to repeal and replace the Affordable Care Act, but the Trump administration continues its sabotage efforts and attempts to undermine the health law that’s helped 20 million people get health insurance.
From refusing to definitively fund subsidies that lower out of pocket costs for low-income people, shortening the open enrollment period, cutting funding for organizations that help people get coverage, weakening the individual mandate, and slashing outreach and advertising funding by 90%, the administration appears to be doing everything in its power to ensure that the ACA won’t succeed.
The Trump administration refuses to give insurance companies certainty regarding whether or not they will continue to make cost-sharing reduction payments. These funds lower deductibles and copays for low-income people on the marketplace – about half qualify for these increased savings. Most insurance companies have mitigated this uncertainty by significantly raising their rates. Trump’s inaction will likely hurt middle and upper income enrollees the most because as we explained in a previous post, tax credits, which go to about 80% of Wisconsinites in the marketplace are likely to absorb much of the increased costs.
In previous years consumers have had three months to shop for and purchase plans on the ACA, but the Trump administration has cut that in half. The open enrollment period under the Trump administration will be just 45 days (Nov 1 – Dec 15). People will have far less time to sign up for coverage than they’re used to having. The administration also slashed its outreach and advertising budget by 90%, likely resulting in fewer people hearing about the ACA and its shortened open enrollment period.
Health and Human Services (HHS) administration officials have also reduced their support for ACA coordination efforts. They substantially cut funding for navigator agencies across the country. In some states cuts to navigator agencies were as much as 92%, and navigator groups in Wisconsin lost nearly half of their federal funds. Since the first open enrollment period, federal employees have attended regional meetings to help coordinate and support enrollment efforts. Officials will no longer attend those events.
HHS also manages healthcare.gov, which consumers in 35 states use to shop for and purchase ACA insurance. The site will be down weekly during open enrollment for ongoing maintenance. It will be shut down from 12 am to 12pm ET every Sunday except December 10. During that time people will not be able to use healthcare.gov to browse or buy insurance. Weekends tend to be busier, so these outages make it harder for people to sign up.
In addition to pulling administrative support, Trump has also issued one executive order and is expected to release another that could substantially undermine the Affordable Care Act. The initial order includes not enforcing the penalty for people who refuse to comply with the individual mandate, an essential balance to support the ACA’s very popular provisions about lifetime limits and pre-existing condition protections.
This week Trump is expected to sign another executive order that will likely further disrupt and destabilize the marketplace. It would allow for the formation of “association health plans,” which could be exempt from the popular requirements of the ACA. Plans could exclude people with pre-existing conditions, offer skimpy benefits that don’t cover services like prescription drugs, mental health, and hospitalization, and charge more for people based on their health status. Younger, healthier people could leave the marketplace in favor of these less generous plans, which could offer lower premiums. If this happened, ACA plans would get more expensive for the people who need regular healthcare. It’s also possible that some insurers would leave the ACA altogether.
President Obama signed the Affordable Care Act into law in March of 2010, in June 2012 the Supreme Court upheld the major provisions of the law, and this year the Republican-controlled Senate was once again unable to get the 51 votes necessary to repeal and replace the ACA.
Despite this, President Trump is using his administrative power to sabotage the law, his bully pulpit to undermine its credibility, and his cabinet members to yank their administrative support for it. Trump has said that Obamacare is imploding, and he’s doing his best to make sure that prediction becomes a reality.
Meanwhile, the ACA has become more popular with Americans who recognize that it, while not perfect, has made great strides in reducing the number of people who don’t’ have health insurance. Now Senators Alexander and Murray are working on a bipartisan bill to stabilize the insurance markets. This is a promising development, and is the path that Congress and the President should be taking. If they fail to do so, and instead continue to sabotage the ACA, it will almost certainly collapse in the next year or two, and it will be clear who would be responsible for the loss of coverage for millions of Americans.