You know there’s trouble when Republican Senators say they’ll only vote for repeal of Obamacare if they’re assured it won’t actually happen.
Trump and Congressional Republican leaders are now left with only their rhetoric. Trump still clings to it. “Let it fail,” he says of Obamacare. “The best thing politically is to let it explode,” he says with detonator in hand.
It may be called Obamacare, but Trump’s using his broad authority over implementation to turn it into Trumpcare, hoping nobody notices health care is in his hands now.
It happens that the only way for Trump to fulfill his own prophecy is to gum up the works. He is monkeywrenching Obamacare.
In an April column I pointed out ways Trump and the GOP could sabotage the Affordable Care Act. Chief among them was elimination of the cost-share subsidies to insurance companies for low-income subscribers, roughly 60 percent of ACA policies.
House Republicans argued in court that while the ACA authorized such payments, the funds still required specific Congressional appropriation, something the GOP Congress has withheld. A federal district judge sided with them but allowed the payments to continue while the issue was appealed.
Consequently, insurance companies have had to approach the 2018 market with uncertainty over the payments, and if there’s one thing markets don’t like it is uncertainty.
Of course Congress could have eliminated the uncertainty by actually appropriating the funds, but they promised to repeal Obamacare, not stabilize it.
Trump has upped the anxiety, calling the payments “ransom money” and claiming he could stop them anytime. In May Trump and House Republican leaders asked the court to delay a ruling, again adding to the uncertainty. Insurers say it’s been a major factor in the very 2018 premium increases Republicans decry.
Insurers and analysts had warned eliminating cost-sharing payments would cause massive increases in payments or mass exodus from markets. Trump is the doom-maker predicting doom.
Another critical element is the mandate to buy insurance. Eliminating it without an adequate replacement mechanism to get enough healthy individuals to sign-up to help keep premiums down was one reason the industry adamantly opposed simple Obamacare repeal. The CBO estimated premiums would rise 15-20 percent if the mandate was dropped.
Trump can’t eliminate it unilaterally, but he’s issued an executive order telling the IRS to relax enforcement of it.
His administration, led by Health and Human Services Secretary Tom Price, has undermined advertising and outreach efforts. In January, at the end of the open enrollment period, Trump withdrew nearly $5 million in advertising to encourage people to sign up. Since then they’ve cut the open enrollment period from 12 weeks to six.
Contracts with two companies that helped facilitate sign-ups in 18 cities were recently canceled.
Price has even begun to use public money allocated for education and outreach to produce and air anti-Obamacare videos showcasing “victims.”
By the time this is published, Congress should be starting its August recess with the media wondering if Trump will ignite a political firestorm by firing Attorney General Jeff Sessions so he can make a recess appointment and rid himself of special counsel Robert Mueller.
But we also should be watching closely to see if Trump cancels the cost-sharing mechanisms, or if Price takes more administrative actions weakening coverage requirements or making it harder for people to sign-up.
Destabilizing Obamacare markets has become the go-to-Trump strategy. No matter what you continue to call it, even without legislation Obamacare is morphing into Trumpcare.