Sabotaging the ACA

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Torpedoing an effort to shore up the exchanges..

Insurers have cited increased political uncertainty as a factor for both increasing premiums in the Obamacare exchanges and pulling out of markets altogether. Alexander and Murray hoped to alleviate some of that uncertainty with new legislation.

Influential Republicans including White House officials and Senate Finance Chair Orrin Hatch came out against the Alexander-Murray push, which helped doom the effort. House Speaker Paul Ryan said that his chamber would not even consider a bipartisan stabilization bill.

Obamacare fix from Lamar Alexander, Patty Murray collapses - Business Insider

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This is getting real petty..

A group of Senate Democrats on Wednesday called for an investigation into the Trump administration’s decision to periodically shut down the federal ObamaCare exchange website in the middle of the next open enrollment period. Sens. Brian Schatz (Hawaii), Elizabeth Warren (Mass.), Cory Booker (N.J.) and Chris Murphy (Conn.) asked the Department of Health and Human Services's (HHS) inspector general to investigate plans for hours-long maintenance shutdowns of the Healthcare.gov website.

“There has been no satisfactory explanation given for why these shutdowns are necessary, and they appear to be part of a pattern by the Trump administration to sabotage the Affordable Care Act,” the senators wrote in a letter to the inspector general's office. HHS officials said the website will be shut down for maintenance from midnight until noon almost every Sunday during the next ObamaCare open enrollment period, which lasts from Nov. 1 to Dec. 15, as well as overnight on the first day of the enrollment period.

Senate Dems demand investigation into ObamaCare website shutdowns | TheHill

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In case you think these are isolated events, there happen to be surprisingly frequent..

For the past three years, the US Health and Human Services Department has partnered with a health advocacy group in Mississippi on an education tour before Obamacare enrollment started. They would meet around the states with groups that sign people up for coverage — state officials, health centers, insurance brokers, and the like — to prepare for open enrollment.

Up until Monday, Roy Mitchell, executive director of the Mississippi Health Advocacy Program, thought these events were going forward in the coming weeks as planned. He had even asked HHS just last week for biographies of the officials they’d be sending. But then two days ago, he received a short message from an agency official, which Mitchell shared with Vox: HHS wouldn’t be doing any Obamacare marketplace events in the South this year. No further explanation was provided. “HHS bailing out was the last straw for us,” Mitchell told me by phone Wednesday. “It’s clearly sabotage.”

The department responded to Vox’s inquiry about the change in part by criticizing the law it is responsible for overseeing...

The Trump administration has already cut this year’s open enrollment period in half. It slashed spending on advertising by 90 percent. Funding for the navigators program, which went to groups that helped people sign up for insurance, was reduced by 40 percent and then allowed to lapse entirely.

With Obamacare facing an uncertain future on so many fronts — over its repeal, over the payment of key subsidies, over the enforcement of the individual mandate — HHS has added the apparent undermining of open enrollment to the plate. A key part of the law is the outreach and education that happens every fall, encouraging young and healthy people to enroll and letting Americans know what assistance is available to them. The Trump administration is cutting back sharply on these efforts — an act people like Mitchell have labeled “sabotage.”

But then there have been less obvious tactics that still undermine the law. Talking Points Memo reported recently that HHS had abandoned an outreach partnership with Hispanic groups that the Obama administration had started. Dropping out of the events in Mississippi is in a similar vein. 
“HHS is a big draw in terms of these meetings. I think it was highly beneficial to hear the policy directly from HHS,” Mitchell said. “Certainly we can go forward, but frankly it was an attempt at collaboration.”

Trump administration abruptly drops out of Obamacare events in Mississippi - Vox

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Apparently the ACA isn't the only healthcare program the Republicans are playing fast and loose with..

Congress will not be able to reauthorize the Children's Health Insurance Program (CHIP) by the September 30 expiration this weekend, sending certain states into a sense of panic as funds begin to dry up. Created during the Clinton administration, CHIP covers nearly 9 million children across the United States in certain middle-class families, which costs taxpayers nearly $14 billion every year, according to Vox. Sens. Orrin Hatch and Ron Wyden, who head the Senate Finance Committee, reached an agreement earlier this month and introduced a bipartisan bill to extend the program for five years. However, there has been little movement and CHIP will not be reauthorized on October 1.

Is Congress reauthorizing CHIP? - Business Insider

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And remember, he is supposed to be the guy that sticks up for the rights of the forgotten masses against the 'elites'

President Trump told the head of the Centers for Medicare and Medicaid Seema Varma to deny a request from the Republican-controlled state of Iowa to fix their health-care marketplace, according to The Washington Post.  According to the Post, Iowa officials sought for months to get federal permission to fix health insurance markets in their state, but they were shut down by Trump administration officials.

Trump told HHS to deny request to fix Iowa ObamaCare market: report | TheHill

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We have to see how this develops, but it looks as yet another way to sabotage the ACA:

With a repeal bill off the table, the Trump administration has drafted an executive order that could blow a huge hole in the Affordable Care Act, according to a source with direct knowledge of the plan. The order would, in effect, exempt many association health plans, groups of small businesses that pool together to buy health insurance, from core Obamacare requirements like the coverage of certain essential health benefits. It would potentially allow individuals to join these plans too, which would put individual insurance marketplaces in serious peril by drawing younger and healthier people away from them. The draft order is also said to broaden the definition of short-term insurance, which is also exempt from the law’s regulations. Together, these changes represent a serious threat to Obamacare: President Trump seems ready to open more loopholes for more people to buy insurance outside the health care law’s markets, which experts anticipate would destabilize the market for customers who are left behind with higher premiums and fewer insurers. “This appears to be a backdoor way of undermining the Affordable Care Act,” Kevin Lucia, who studies the markets at Georgetown University, said of the alleged changes.

How Trump is planning to gut Obamacare by executive order - Vox

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Keep Americans safe..

So Trump is now wrecking Obamacare himself, by executive order:

The order calls for allowing so-called association health plans and short-term insurance plans, and it includes broad language instructing various departments to look at ways to reduce insurance costs. Trump made it clear during a ceremony where he signed the order that the action was designed to undermine and start to unravel the ACA, the healthcare law also known as Obamacare.

"We've been hearing about the disaster of Obamacare for so long — in my case most of it outside in civilian life and a long period of time since I started running and for a long time since I became president of the United States," Trump said. "I just keep hearing repeal, replace, repeal, replace. Well, we're starting that process."

The order directs the relevant agencies to craft the outlined changes through regulations, which are subject to the normal approval process. This most likely means they would go into effect for the 2019 insurance year at the earliest. Association health plans allow people in the ACA's individual or small-group insurance exchanges to pool together to purchase insurance at a more favorable rate. These plans would also not be subject to certain Obamacare regulations, which could help make them even cheaper for people participating, The Wall Street Journal previously reported.

In addition, the order is expected to instruct the Labor Department to look into allowing the sale of these insurance plans across state lines. Trump has long espoused the idea of selling insurance across state lines, but there are doubts about how effective it would be in actually bringing down costs.

Short-term insurance plans are cheap but cover little. The Affordable Care Act prevents people from buying these plans for more than 90 days, but the new order could allow people to purchase them for up to a year. Both executive orders appear to be targeted at allowing healthier, younger people to obtain lower-cost options than what is currently available in the Obamacare exchanges.

But experts say the order could leave behind older and sicker people currently are getting insurance through the Obamacare markets. "Loosely regulated association plans could charge lower premiums to healthy people, effectively leaving ACA marketplaces as high-risk pools," tweeted Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan health policy think tank. Levitt continued: "With this executive order healthy people could pay less for insurance, but middle-income people with pre-existing conditions pay more."

That means healthier people would rely on the cheaper, deregulated plans allowed under the new rules. Since sicker people would need more generous plans, they would likely remain in the more regulated Obamacare exchanges. As the percentage of sick people in the exchanges increases, it would be more costly for insurers in that market. And as costs increase, so too would the prices insurers charge in the exchanges..

Trump executive order on healthcare, insurance, Obamacare plans - Business Insider

Loosely regulated association plans could charge lower premiums to healthy people, effectively leaving ACA marketplaces as high-risk pools, that is, it sets a deliberate death spiral in motion. 

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This is amazing stuff. He did it out of spite, say the Democrats, and this certainly seems the case if you read the effects per the CBO, there is actually no upside. Even the budget deficit will increase as a result, never mind the higher premiums, people losing insurance..

President Trump plans to cut off key payments to insurers selling ObamaCare coverage, the White House announced late Thursday. The action represents Trump's most aggressive move yet to dismantle ObamaCare, after GOP efforts to repeal and replace the health-care law failed this year. Trump has repeatedly threatened to cut off the disbursements to insurers, known as cost sharing reduction (CSR) payments, which are worth an estimated $7 billion this year. The White House said Thursday night that the administration "cannot lawfully" make the payments.

Trump to cut off key ObamaCare payments | TheHill

Democratic leaders blasted the administration on Thursday night over President Trump's decision to end key payments to insurers offering ObamaCare coverage, calling the move "spiteful." “Sadly, instead of working to lower health costs for Americans, it seems President Trump will singlehandedly hike Americans’ health premiums," Senate Minority Leader Charles Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) said in a joint statement. "It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America. Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it," they continued. 

The Congressional Budget Office (CBO) said in August that insurance companies would raise premium prices by about 20 percent for ObamaCare plans if the payments were cut off, saying that around 1 million people would be uninsured in 2018. The CBO also said that cutting off the payments would raise the federal deficit by $194 billion through 2026.

“President Trump has apparently decided to punish the American people for his inability to improve our health care system. Trumpcare collapsed because Americans overwhelmingly recognized the cruelty and higher costs it meant for them and their loved ones. Now, millions of hard-working American families will suffer just because President Trump wants them to," Schumer and Pelosi said.

Dems rip Trump's 'spiteful' decision to end key ObamaCare payments | TheHill

Some health insurers had already increased their premiums for Obamacare plans in 2018 by as much as 20 percent because of Trump’s threats to cut off the payments. A permanent end to the subsidies could imperil the law’s marketplaces in the long term and lead to even bigger price hikes in future years. Health plans could potentially sue the Trump administration to force the payments to be made, as they have on earlier occasions when Republicans sought to cut off federal funding provided under Obamacare. States have also taken steps to prepare for the possibility Trump would pull the payments, and most 2018 rates have already been finalized. So premiums might not be immediately affected any more than they already have been.

Trump will pull Obamacare subsidies in another attack on health law - Vox

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Vox on the cutting of the insurance subsidies:

There is no question that this new policy is lose-lose-lose for key stakeholders with no upside:

• It will raise Obamacare premiums by an estimated 20 percent in 2018, as health plans have to charge more to make up the lost funds. By 2020, premiums would increase 25 percent due to this change.
  
• Pulling the plug actually increases the national deficit. As those insurance plans make double-digit rate increases, the government will have to spend billions more on the other subsidies that 10 million Americans receive to purchase that coverage.
  
• The Congressional Budget Office estimates that this move will ultimately cost the government $194 billion over the next decade.
  
• The number of uninsured Americans would rise by one million people in 2018, in the CBO’s estimate.
  
• Insurance companies lose out, too, particularly those that assumed Trump would pay these subsidies and set their premiums accordingly. They now stand to face significant financial loses on the Obamacare marketplaces.
  

To recap: Trump is enacting a policy where the government spends billions more to insure fewer people.
This is a policy that helps nobody and hurts millions. And that is actually different from the other health care policies Trump and congressional Republicans have pursued.

The executive order Trump signed yesterday, for example, would let skimpier health insurance plans back into the individual market. That would benefit people who are young and healthy (and don’t want to spend a lot on premiums) at the expense of making it worse for those who are old or sick — a 180 from the point of Obamacare. (Republican plans in Congress to repeal Obamacare, too, would have advantaged certain groups of people while disadvantaging others.)

This decision is perhaps the most aggressive one Trump has made so far in his committed push to explicitly undermine the key objectives of the law.
Ending these payments raises premiums for anyone who uses Obamacare: older people, younger people, sicker people, and healthy people. And it puts an already fragile Obamacare marketplace at greater risk of a last-minute exodus by health plans who assumed that the government would pay these subsidies — and don’t think they can weather the financial hit.

The Trump administration has, since taking office, cut the Obamacare open enrollment period in half. Instead of 90 days to sign up, enrollees will now get 45. The Trump administration has cut the Obamacare advertising budget by 90 percent — and reduced funding for in-person outreach by 40 percent. Regional branches of Health and Human Services abruptly pulled out of the outreach events they have participated in over the last four years.

Obamacare is, in Washington, a political football — something Republicans have spent seven years promising to repeal. Now, Trump is doing more than Congress ever could to make good on that promise. Trump’s larger presidential agenda has focused on unwinding Barack Obama’s legacy. He’s more focused on destroying his nemesis than trying to replace, to fix, or to improve Obama’s biggest accomplishments from the Iran deal to environmental regulation.

On health care, there are going to be immediate and very real consequences for Americans. There are real people who stand to be hurt by an administration that has actively decided to make a public benefits program function poorly. Trump has long predicted the implosion of the Affordable Care Act. It’s now become clear he plans to use the White House to tear down his predecessor rather than to help the people who voted him into office.

Trump’s acting like Obamacare is just politics. It’s people’s lives. - Vox

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Holding Democrats hostage is one thing, but sick people?? Playing fast and loose with people's health?!

Donald Trump has turned Obamacare repeal into a hostage situation. With repeal and replace stalled, President Trump is now doing everything he can to destabilize health care markets in a desperate attempt to force Democrats to come to the negotiating table.

After dramatically cutting advertising and outreach, the Trump administration announced on Thursday evening that it would end cost-sharing reduction subsidies that help millions of lower-income Americans afford health insurance. According to the Congressional Budget Office, the move will increase premiums by 20 percent by 2018 and 25 percent in 2020 while adding billions to the deficit. On Friday morning, Trump made it clear that these moves were being made for entirely political reasons:

[/url][url=https://twitter.com/realDonaldTrump] Follow
Donald J. Trump 

✔@realDonaldTrump
The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!
6:36 AM - Oct 13, 2017

Congress failed to repeal and replace Obamacare in part because it would create this exact situation: costs will go up and coverage will decrease. These moves to gut Obamacare do nothing to make health care more affordable, as Trump repeatedly promised he would do during the 2016 campaign, and instead aim to create a situation in which millions lose their health care, prompting Democrats to act.

Trump is, in effect, creating a hostage situation, something he’s repeatedly threatened to do in the past. But it’s highly likely this gambit will backfire. These moves—coupled with the administration’s troubling demands regarding a legislative solution for Dreamers—substantially increase the likelihood of a government shutdown.

Donald Trump has turned Obamacare repeal into a hostage situation. | New Republic