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Sabotaging the ACA
Quote:Over the past two weeks, two insurers have made it clear just how Trump's policies could cause healthcare costs for average Americans in these exchanges to increase by more than they would otherwise.

In Pennsylvania, Insurance Commissioner Teresa Miller announced on Thursday that the premium for a baseline Obamacare exchange plan would increase by an average of only 8.8% for 2018 compared to this year. This is lower than the 10.5% increase between 2016 and 2017. But Miller warned that premiums could go much higher if Trump makes just a few policy changes.

According to Miller, if Trump announces he will stop enforcing the individual mandate that compels people to buy coverage, premium requests from insurance companies would increase by an average jump of 23.3%.

Additionally, if Trump stops making cost sharing reduction (CSR) payments, insurers would ask for a 20.3% increase on average. CSR payments offset the cost for insurers of providing lower out-of-pocket costs to poorer Americans. Health policy experts have said the payments are critical and without them, Trump's predictions of a "collapse" in the market could come true.

If both changes are made, insurers would ask for a 36.3% increase, according to Miller.
North Carolina, Pennsylvania insurance premiums increase due to Trump - Business Insider
Happy now, guys?

Quote:Anthem on Tuesday announced it would not participate in the individual health-insurance exchanges in Ohio for the 2018 plan year. That could leave 20 counties in the state without any plans on the marketplaces established by the Affordable Care Act, the healthcare law better known as Obamacare. In a statement to Business Insider, Anthem cited "continual changes in federal operations, rules, and guidance" as its primary reason for exiting the marketplaces. The insurer said disruptions in the market because of possible policy changes from the Trump administration and lawmakers on Capitol Hill led to the decision.
Anthem to exit 2018 Obamacare insurance exchange - Business Insider
Quote:Andy Slavitt, acting administrator for Centers for Medicare and Medicaid Services (CMS) under President Obama, penned an op-ed in The Washington Post Saturday that slams Senate Majority Leader Mitch McConnell (R-Ky.) for using “sabotage, speed and secrecy” to work on passing the GOP healthcare bill in the upper chamber.

Slavitt said McConnell should rewrite the House-passed healthcare bill that repeals and replaces key ObamaCare provisions, given the Congressional Budget Office analysis that showed 23 million people would lose healthcare under that plan.  "Faced with that reality, McConnell could have started over and had the Senate develop its own legislation, perhaps even working with Democrats on a bipartisan alternative that could withstand the test of time,” Slavitt wrote. “Instead, McConnell put a plan in place to pass something close to the House bill using three simple tools: sabotage, speed and secrecy.”
Ex-Medicare head: GOP using 'sabotage, speed and secrecy' to pass ObamaCare repeal | TheHill
Where is the rationale?

Quote:When Obamacare was enacted, Republicans had some claims, almost a theory, about why it was a terrible idea. It would, they claimed, fail to improve coverage. It would be a massive “job-killer”. It would cost far more than predicted, and blow up the budget deficit.

In reality, the percentage of Americans under 65 without insurance fell from 18 percent in 2010, the year Obamacare was enacted, to 10 percent in 2016 (and less than 8 percent in Medicaid expansion states). Unemployment was 9.9 percent when the ACA was passed, 6.6 when it went into full effect, 4.8 by January 2017. Costs have come in well below expectations.

There have been some disappointments: fewer people than expected signing up for the exchanges, although this has been offset by the surprising durability of employment-based coverage and stronger than expected Medicaid. But the point is that none of the things Republicans cited as their reason for opposing the bill have come true.

So what’s the theory behind their proposed replacement? Where’s their analysis showing that it will be better? There’s no hint of anything on either topic. You might have expected some kind of appeal to the magic of the market, some claim that radical deregulation will produce wonderful results. It would have been silly, but at least would have shown some respect for the basic idea of analyzing policies and evaluating them by results.

But what we’re getting instead is a raw exercise of political power: the GOP is trying to take away health care from millions and hand the savings to the wealthy simply because it can, without even a fig leaf of intellectual justification.
We're Not Even In Kansas Anymore - The New York Times
This is outrageous, it's here in black and white, blackmail with the most vulnerable people's healthcare coverage:

Quote:During an off-camera briefing on Monday, Press Secretary Sean Spicer signaled that the Trump administration is willing to use low-income Americans’ health insurance as a bargaining chip to persuade Congress to pass Trumpcare, which will result in tens of millions of Americans losing their health insurance.

Spicer detailed the administration’s position in response to a question about whether the Trump administration will cover next month’s cost-sharing reduction (CSR) payments for low-income people who purchase health insurance on the Obamacare exchanges. As ThinkProgress has previously detailed, the payments “partially subsidize deductibles and co-payments for more than 7 million low-income Americans, making it possible for many of them to afford their insurance. Cutting off the payments could potentially kick millions of people off the state exchanges, pushing some private insurers to withdraw as well. Premiums could shoot up across the board.”

Spicer made clear that the administration will do what it can to continue to destabilize Obamacare exchanges by only committing to the CSR payments one month at a time. “We committed to making them last month, and that’s as far as we will go at this time,” Spicer said. “We’re not committing to them this month.”
White House threatens to sabotage insurance of low-income people if Trumpcare isn’t passed
Quote:Tales of Obamacare’s demise have been greatly oversold. In many states, the marketplaces are actually doing just fine, with moderate premium increases and healthy enrollment. There is no death spiral. An analysis released by the Kaiser Family Foundation earlier this week examining the current state of Obamacare’s marketplaces found that “the individual market has been stabilizing and insurers are regaining profitability.”

But Obamacare’s marketplaces have certainly encountered problems in some areas. Premiums have quickly increased in other parts of the country. And Kaiser 
lists 38 counties—covering 25,133 enrollees—that are at risk of having no insurers selling coverage on the marketplaces in 2018. That’s a small subsection of the more than 10 million people who signed up for 2017 insurance, but it’s a severe problem for the people in those 38 counties, since the government subsidies they are entitled to are only available for insurance offered on the marketplaces.
For all their griping about the ways Obamacare isn’t working, Republicans are leaving out one key fact: Many of the law’s troubles can be traced back to opposition and sabotage by Republicans themselves:

  1. Opposing Medicaid expansion
  2. Cutting insurance subsidies
  3. Playing chicken with cost-sharing reductions
3 Ways Republicans Have Already Sabotaged Obamacare – Mother Jones

See article for the details.
Obamacare is exploding, but basically only in Republican's own back yard. Now why would that be...

Quote:When he talks about his efforts to repeal the Affordable Care Act, President Trump almost always asserts that Obamacare is “exploding.” Republican members of Congress make similar claims, insisting that Obamacare is unsustainable—and that they therefore have no choice but to “repeal and replace” it. 

There is some basis for this argument. More than 1,300 counties only have one insurer in their exchanges, meaning there is no competition. But there is a nuance that Republicans willfully ignore: This is a problem of their own creation that is largely confined to red states. Where Republican governors have sought to sabotage the program, they have largely succeeded. Where Democratic governors have tried to make the ACA work, they too have largely succeeded

Here are the basic numbersIn states with Republican governors, more than 40 million people live in counties with only one insurer. In states with Democratic governors, there are 10.7 million people who live in such counties. Republican governors had little interest in making their exchanges work. The difference is far more dramatic if we exclude North Carolina from the Democratic list. While North Carolina does now have a Democratic governor, it had a Republican governor until January, and even now the Legislature is overwhelmingly Republican

Not counting North Carolina, only 2.1 million people in Democratic states live in counties without competition. Put another way, if someone lives in a state with a Democratic governor other than North Carolina, they have a 1.8% probability of only having a single insurer in their exchange. If they live in a state with a Republican governor, there is a 20.7% probability of the same.

There are two main ways in which Republican governors have been effective in sabotaging Obamacare in their states. The first and most important was by refusing to expand Medicaid.

The other issue is the extent to which states took the initiative to promote Obamacare. Less healthy people generally don’t have to be prodded to buy insurance, since they know they need it. The issue is whether more healthy people buy into the system. Insurers are going to lose money if all the people they insure have serious health problems.

Democratic governors generally tried to persuade people to buy insurance, while Republican governors were more often neutral, if not openly hostile, to the program. As a result, fewer healthy people bought into the exchanges in their states, making the system less profitable for insurers.
Obamacare is only 'exploding' in red states - LA Times
Quote:Unfortunately, some of those gains will probably be lost all the same: The number of uninsured Americans is likely to tick up over the next few years. So it’s important to say clearly, in advance, why this is about to happen. It won’t be because the Affordable Care Act is failing..., when Trump threatens to “let Obamacare fail,” what he’s really threatening is to make it fail.

On Wednesday The Times reported on three ways the Trump administration is, in effect, sabotaging the A.C.A.... First, the administration is weakening enforcement of the requirement that healthy people buy coverage. Second, it’s letting states impose onerous rules like work requirements on people seeking Medicaid. Third, it has backed off on advertising and outreach designed to let people know about options for coverage. ...

And there may be worse to come: Insurance companies, which are required by law to limit out-of-pocket expenses of low-income customers, are already raising premiums sharply because they’re worried about a possible cutoff of the crucial federal “cost-sharing reduction” subsidies that help them meet that requirement.

The truly amazing thing about these sabotage efforts is that they don’t serve any obvious purpose. They won’t save money — in fact, cutting off those subsidies ... would probably end up costing taxpayers more money than keeping them. They’re unlikely to revive Trumpcare’s political prospects.

So this isn’t about policy, or even politics in the normal sense. It’s basically about spite: Trump and his allies may have suffered a humiliating political defeat, but at least they can make millions of other people suffer.

Can anything be done to protect Americans from this temper tantrum? In some cases, I believe, state governments can insulate their citizens from malfeasance at H.H.S. But the most important thing, surely, is to place the blame where it belongs. No, Mr. Trump, Obamacare isn’t failing; you are.
Economist's View: Paul Krugman: Health Care in a Time of Sabotage
Let Obamacare implode, threatening to destabilize the markets. This is the President of the US, playing politics with the healthcare of millions of people for political gain. It's incredible..

Quote:But Trump didn't stop there — later Saturday afternoon he called for a new healthcare bill to be approved, and appeared to threaten congressional members' health benefits and cost sharing reduction (CSR) payments meant to stabilize the individual insurance market. "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!" Trump tweeted. "Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!"
Trump goes off on Republican senators in Saturday tweetstorm - Business Insider

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Another perspective on Trump's Tweets:

Quote:Donald J. Trump ✔ @realDonaldTrump If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon! 1:27 PM - Jul 29, 2017 39,139 39,139 Replies 27,129 27,129 Retweets 98,028 98,028 likes Twitter

Donald J. Trump ✔ @realDonaldTrump Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill! 5:36 PM - Jul 29, 2017 36,444 36,444 Replies 20,784 20,784 Retweets 84,346 84,346 likes  

These two tweets contain three distinct threats, each more potentially destabilizing than the preceding one.
  • First: Trump is threatening to abrogate a federal obligation under the Affordable Care Act to subsidize insurance companies that cover low income beneficiaries—a step that would approximate the impact of the most recent failed Obamacare repeal bill. He is promising, in other words, to sabotage insurance markets, exploding premiums and driving issuers out of the market, unless the Senate passes legislation to uninsure millions of people in its own way. 
  • Second: Trump is threatening to withdraw an Obama administration rule that allowed members of Congress and their aides to port their federal premium contributions into the D.C. insurance exchange, so that, like most employees of large organizations, they aren’t forced to bear the full cost of their health benefits. On a first-order level, this is obviously less harmful than the threat to millions of unsuspecting private citizens, but the worst potential second-order effects—massive brain drain on Capitol Hill, the paralyzing impairment of an understaffed legislature—would be catastrophic. 
  • Third, Trump is hinting at a new standard, under which he will veto all legislation Congress passes until the Senate passes a health care repeal bill. On Sunday his budget director, Mick Mulvaney, clarified that it is the “official White House position” that Congress should not move on to any other issue until the health care process gets underway again.
It is against the backdrop of his reflexive need to avenge his humiliations with mindless vandalism that Trump has fired his chief of staff and replaced him with a retired military general who has authoritarian tendencies of his own.
The Presidency in Exile | New Republic


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