Sabotaging the ACA

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The Trump administration is quietly dismantling the Affordable Care Act, taking a series of regulatory steps that will make it easier for insurance companies to sell plans that exclude patients with preexisting conditions or don’t cover basic services like maternity care, mental health treatment, and prescription drugs. Republicans weren’t able to repeal Obamacare in Congress. Now the Trump administration appears to be settling for the second-best thing: weakening Obamacare’s insurance regulations, changes that will hurt Americans who are older and sicker while benefiting the young and the healthy. The Health and Human Services Department published new rules Tuesday that widen access to “short-term” health plans, a small subset of insurance products that are meant to cover short gaps in insurance coverage. The Obama administration aggressively regulated these plans, allowing insurance companies to sell them only as 90-day options.

Already in recent weeks, the Trump administration has shown little interest in enforcing Obamacare’s guarantee that healthy and sick people get access to the same type of health insurance. For example, it hasn’t intervened in Idaho, where regulators recently told insurers they can simply disregard many of the Affordable Care Act rules and sell new “freedom plans” that discriminate against sicker enrollees. Typically, you’d expect the federal government to get involved — to step in and enforce federal law when a state refuses. But when pressed by a reporter on this issue Tuesday, HHS Secretary Alex Azar demurred. “I’m not in a position to rule on something I’ve seen a media report about,” he said, adding that he doesn’t “believe in premature opinions on complex topics.”

Trump’s quiet campaign to bring back preexisting conditions - Vox

Freedom plans, how sick is that..

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With the deadline to pass an omnibus budget bill to fund the federal government just a few weeks away, Congress is considering a rescue package for Obamacare’s troubled individual market, including funding for stabilization measures aimed at bringing down rising insurance premiums.
Lawmakers pushing the effort—begun back in the summer and fall of 2017—are hoping to counteract the damage to the individual market caused by a string of Trump administration moves, from terminating cost-sharing reduction payments for  insurance companies to defunding open enrollment outreach to encouraging the proliferation of cheap, skimpy, off-market health plans.

Congress Weighs Rescue Package For O’Care As Trump Admin Hacks Away At Market – Talking Points Memo

Congress will get one last shot later this month to pass a modest plan to help fix the Obamacare marketplaces — that is, unless the Trump administration torpedoes what has been until now a very uneasy truce. After months of discussions, a pair of plans — one negotiated by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), the other from Sens. Susan Collins (R-ME) and Bill Nelson (D-FL) — would inject billions of dollars of federal money into the insurance markets, while also giving Republicans a win by providing some more administrative flexibility for states to pursue their own health care programs.

But then on Tuesday, Politico and the Wall Street Journal reported that the White House is making some deeply conservative demands if Trump is going to support a stabilization plan. They want to place abortion restrictions on federal tax credits, they want to allow insurers to charge older people even higher premiums, and they want to expand short-term insurance plans that don’t have to comply with Obamacare’s rules.

Trump might have blown up the last best hope to stabilize Obamacare - Vox

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How about this for sabotage..

The Trump administration argued in a court brief filed on Thursday that Obamacare’s protections for preexisting conditions should be ruled unconstitutional, opening up another front in the White House’s crusade to roll back the law’s core insurance reforms. The brief was filed in a case brought by several conservative states, led by Texas, which argued that because Republicans in Congress repealed Obamacare’s individual mandate penalty in their tax bill, the mandate is now unconstitutional — and so is the rest of the law.

The Trump administration believes Obamacare’s preexisting conditions protections are now unconstitutional - Vox

The effect, if implemented would be millions of those who most need it losing healthcare, thousands will die unnecessary. Keep American's safe, huh?

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How about this for sabotage (from Admin's posting here)..

The Trump administration has agreed in part, saying the mandate and the law’s popular protections for preexisting conditions should be nullified in a recently filed legal brief. “Those parts that the court explicitly upheld under the taxing power, the Department of Justice conceded, under the court’s reasoning, no longer had a constitutional basis,” Cruz, who studied law at Harvard and served as Texas’s solicitor general before coming to Congress, told me. “I think that is a reasonable position for the Justice Department to take.” “I think the consequence if the court agrees with the state of Texas’s lawsuit will be that consumers will have more choices, more competition, more options, more individual freedom and lower premiums,” he continued. “That’s a win for health care consumers across the country.”

The left-leaning Urban Institute just estimated that the number of uninsured Americans would jump to 51 million, a 50 percent increase, if the Texas case were successful and the entire law were found unconstitutional. Legal experts, on the right and the left, have said that the Trump administration’s position in the case is “absurd” and “ludicrous” because if Congress had intended to invalidate the preexisting conditions rules along with the mandate penalty in the tax bill, they would have. A senior career Justice Department attorney also resigned following the administration’s decision not to defend the health care law, as the Washington Post reported.

Ted Cruz defends lawsuit to overturn Obamacare preexisting condition rules - Vox

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The repeal of the mandate penalty was the latest in a long line of actions that the Trump administration has taken to deliberately undermine the ACA marketplaces. President Trump himself has not exactly been subtle about this, remarking last year that “the best thing we can do politically speaking is let ObamaCare explode.” Similarly, former White House advisor Steve f exclaimed, “That’s going to blow that thing up — gonna blow those exchanges up, right?” when describing Trump’s decision to cancel ACA cost-sharing payments last year.

Congress knew in advance that the individual mandate played an important role in stabilizing the market, and that repealing the mandate penalty would cause premiums to go up. The non-partisan Congressional Budget Office estimated that repealing the mandate penalty would increase individual market premiums by 10 percent on average in 2019. In fact, Trump’s own former Secretary of Health and Human Services, Tom Price, recently admitted that the repeal “actually will harm the pool in the exchange market because you'll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks in that market."

Here’s how Trump’s tax law is raising health insurance premiums | TheHill

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Another piece of the Affordable Care Act’s machinery is grinding to a halt, at least for the moment, in what could be another effort to undermine the law by the Trump administration. The Department of Health and Human Services announced on Saturday that it is temporarily suspending a series of payments to insurers that flow through the ACA’s “risk adjustment” system. HHS presented the decision as a necessary response to a recent ruling by a federal district court. The Wall Street Journal had reported Friday evening that such an announcement was imminent and HHS, in its official statement, said it hoped to resolve the matter soon ― first and foremost, by asking the judge to reconsider his decision. 

“We were disappointed by the court’s recent ruling,” Seema Verma, Center for Medicare and Medicaid Services (CMS) administrator, said. “As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold. CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets.” But some experts say the administration is handling the matter in a way that is unnecessarily slow and disruptive ― and is a direct outgrowth of GOP hostility to Obamacare. 

“Trump’s HHS seems to be jumping at yet another opportunity to undercut the ACA’s effort to structure a fair, functioning marketplace for individual insurance,” Jon Kingsdale, a former Massachusetts state health care official, told HuffPost after reading the initial reports. “On top of a half-dozen other hits to the ACA marketplace, this will add to health plans’ anxieties about getting stuck with a deteriorating risk pool.” Andy Slavitt, who oversaw the ACA while serving in the Obama administration, reacted to the initial news with a tweet that called the decision “aggressive and needless sabotage” of the law.

Trump Administration May Be Preparing A New Obamacare Sabotage Effort | HuffPost

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The Trump administration has been deliberately sabotaging the ObamaCare exchanges. Most recently, it announced that it would again slash funding to "navigators," the nonprofits that help people navigate the complicated enrollment process. For 2017 the funding was $62.5 million; now it's down to $10 million. Worse, the navigators will now be directed to recommend that people enroll in crummy, cheap plans — potentially causing an insurance death spiral as the healthy population is creamed off into garbage plans, leaving only sick people in the other insurance pools.

That comes on top of the GOP's evisceration of ObamaCare advertising and outreach and the deletion of "cost-sharing reduction" payments. Ironically, this latter move may have accidentally helped people on the exchanges slightly (due to the policy's janky design), but all these moves have been unquestionably aimed at worsening the quality of coverage on the ObamaCare exchanges..

Now, it is true that ObamaCare was a cramped vision of health policy that is way too complicated and has some rather staggering design errors. Nevertheless, its exchanges and Medicaid expansion have provided coverage to millions of people, and its regulatory structures have helped tens of millions more with employer-based coverage. At every point where Trump's appointees could have chosen to operate the federal bureaucracy to make coverage cheaper and better, they have chosen the opposite.

More fundamentally, Republicans have had the run of all three branches of government for the last year and a half — a rare situation in our antiquated constitutional system. In a democracy, the government is supposed to address the needs of its citizens. There are lots of health-care models that might provide universal coverage — and in a dark sort of advantage, the American health-care system is so terrible that practically every other country that isn't an outright failed state is doing better than us, giving us plenty of models to choose from. All we would need is to copy-paste from somewhere with a demonstrated functioning model — from the public-private mix in Switzerland to Medicare-for-all systems in many countries to the National Health Service in Britain. Heck, you could just draw a country out of a hat, and go with that — it might not be the best option overall, but it's certain to be better than our festering, gangrenous system.

Republicans promised over and over and over again that their alternative to ObamaCare would offer coverage that is both cheaper and better. Paul Ryan said their policy would protect people with pre-existing conditions. Kellyanne Conway promised that Medicaid would be protected, while then-Secretary of Health and Human Services Tom Price swore up and down that nobody would be kicked off that program.

In reality, as even a cursory glance at the health-care bill the GOP repeatedly failed to pass last year reveals, Republicans' actual policy preference is to slash social insurance programs (particularly Medicaid) and other health-care subsidies and regulations, causing tremendous suffering and probably hundreds of thousands of deaths annually, so they can cut taxes on rich people. It was only the defection of three Republican senators — swayed by a deluge of constituent calls, many begging not to be killed — that prevented that goal from being achieved.

The GOP's stealth campaign to sabotage your health care

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The Trump Administration this week slashed funding for consumer enrollment assistance and outreach through the Affordable Care Act (ACA) navigator program. The funding cuts, and other changes to the program, will reduce access to crucial assistance that helps consumers make informed decisions about their insurance and sign up for and maintain comprehensive coverage – yet another in the Administration’s efforts to weaken the ACA. The latest cut reduces funding for the navigator program to just $10 million for the 34 states whose ACA marketplaces are facilitated by the federal government. Combined with the large cut last year, navigator funding has now fallen more than 80 percent from its 2016 level.

In Latest ACA Sabotage, Administration Nearly Eliminates Marketplace Enrollment Assistance Funds | Center on Budget and Policy Priorities

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Another angle opening up

But supporters of the health care law, if anything, underestimate the dangers to the law posed by conservative legal challenges and a rightward shift on the Court. Aspects of Kavanaugh’s jurisprudence as it relates to health care, especially his views about executive power, raise concerns that deserve more attention than they have been given so far —particularly because the president and his agencies have been using their powers to sabotage the ACA for more than a year.

One highly politicized challenge to the ACA coming out of Texas has indeed received a lot of attention: It turns on the question of whether the entire health care law should be struck down now that Congress has eliminated the ACA’s penalty for failing to comply with the so-called “individual mandate” to buy health insurance under the law. But the ACA is under attack on multiple legal fronts; anyone concerned needs to focus on more than just Texas. Taken together, these challenges threaten to end the ACA’s essential protections, including a minimum level of care for all and guaranteed access to quality health care regardless of preexisting conditions.

Kavanaugh’s appointment to the Supreme Court: the implications for Obamacare - Vox

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In setting premiums for 2019, insurers are taking account of several policy changes that will be newly in effect for the 2019 plan year, including repeal of the individual mandate penalty and Trump Administration actions to expand the availability of plans that are exempt from various Affordable Care Act (ACA) requirements. These policy changes are generally expected to cause many healthier people to leave the individual market and thereby raise individual market premiums.

In a stable policy environment, average premiums for ACA-compliant plans would likely fall in 2019: Fiedler’s analysis defines a “stable policy environment” as one in which the federal policies toward the individual market in effect at the start of 2018 remain in effect for 2019. Notably, this scenario assumes that the individual mandate penalty and limits on short-term, limited duration insurance policies remain as they were at the start of 2018, but does not assume the reversal of policy changes that were already in place at the start of 2018, like the end of CSR payments. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs.

How would individual market premiums change in 2019 in a stable policy environment?

That is, Trump's policy actions are causing premiums to rise, without only the latest of these, premiums would fall in 2019!