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UPDATE: After this post’s publication, the Trump administration announced in a late-night press statement that it would stop payments intended to help lower-income enrollees reduce their out-of-pocket costs for things like copayments and coinsurance.

Withdrawing this critical funding will drive up premiums for millions of individuals and families. The result: more people going without coverage – and destabilization of the entire health insurance market.


Congress’ attacks on Obamacare have failed time and time again — but the Trump administration is making a frenzied effort to undermine Obamacare from the inside.

In July, as one of the bills designed to repeal the Affordable Care Act (ACA) crashed and burned, a petulant President Trump tweeted a hint that he might pursue a different strategy:

Since then, it’s clear President Trump is wielding his power to breathe life into the make-believe notion that Obamacare has failed. He’s doing it through deliberate, blatant sabotage of the health coverage that millions depend on.

In his boldest step yet, Trump today signed an executive order to undermine the health care that millions of Americans rely on. Experts agree that the plan will result in lower quality health care plans, additional costs to taxpayers, and weaker consumer protections. The so-called ‘association health plans’ encouraged by Trump’s order often lack protections for Americans with preexisting conditions, exclude maternity coverage that approximately 13 million women gained under the ACA, and put the financial security of policyholders at risk.   

The lower premiums of the newly created plans would recruit younger, healthy buyers away from more comprehensive policies. The departure of enough of those buyers from the marketplace would, according to former Medicare and Medicaid administrator Andy Slavitt, effectively turn the ACA marketplace “into a high-risk pool” — with astronomical premiums that fewer and fewer Americans could afford.

The stakes are enormous. Thanks to other administration efforts to sabotage the ACA before open enrollment, many Americans eligible for coverage and subsidies could miss the deadline and enter 2018 uninsured.   


The steps Trump has taken to sabotage the ACA include:  

1. Cutting the length of the enrollment period in half.

Under President Obama, the health-care marketplaces began open enrollment on November 1 — and continued it through the end of January. Under recently departed Health and Human Services Secretary Tom Price, however, officials in charge of enrollment made a different call, quietly announcing that the enrollment period for 2018 coverage would end on December 15.

The result: “enrollees will get 45 days to sign up for coverage instead of 90.”

2. Decimating the advertising budget.

Via conference call, administration officials announced at the end of August – a mere two months ahead of the 2018 enrollment period – that it would refuse to spend 90 percent of the money budgeted to promote the health care marketplaces. From the 2017 level of $100 million, HHS opted to slash ad spending to a mere $10 million.

That reduction will likely lead fewer people to enroll. After Kentucky zeroed out television advertising for its health-care marketplace, enrollment slid from 106,000 in 2015 to 81,000 in 2017.


3. Gutting the Affordable Care Act ‘navigators’ program.

Health insurance, especially for those without the privilege of spending most of their lives covered by it, is complicated. That’s why the Affordable Care Act sets resources aside for so-called “navigators”: nonprofit groups that work to help people understand and choose from their insurance options.

This summer, federal officials acted with little warning to take away 40 percent of navigators’ funding. Some nonprofits saw their grants slashed by as much as 92 percent. The cuts came after the nonprofits received assurances that their work would continue as it had under Obama — leading many to hire staff, place ads, and rent office space they can no longer afford. “In the face of such numbers, some navigator groups have simply quit,” the New York Times reports.

We had no forewarning,” a navigator at a Maine nonprofit told the Times. “This is heartbreaking.


4. Boycotting states’ open-enrollment events.

Under Obama, federal officials would travel the country to raise awareness in advance of open enrollment — but late in September, BuzzFeed reported the Department of Health and Human Services had ordered its regional directors to drop out of such events. The news broke through a leak in Mississippi, where a health-advocacy program learned with a mere week’s notice that federal officials would pull out of long-scheduled events.

When asked about the abrupt cancellation, the press secretary at HHS — the department entrusted to faithfully implement the Affordable Care Act — issued a statement declaring that “the American people … continue to be harmed by Obamacare’s failures.”

I didn’t call it sabotage,” the leader of the Mississippi health-advocacy group told BuzzFeed. “But that’s what it is.”


5. Turning Healthcare.gov off on Sundays. (Really.)

HHS announced — by way of a slide in a conference-call presentation — that Healthcare.gov, the federal enrollment portal, would go offline for 12 hours on every Sunday during the enrollment period but one. The shutdowns eliminate a fourth of the weekend enrollment time often used by families for major purchasing decisions.

The outages, an HHS spokesperson explained, permit “maintenance” during the “lowest-traffic time periods” — but former Obama administration officials have called shenanigans. The ex-chief information officer of HHS tweeted that “no insurmountable tech challenges … require Healthcare.gov to be offline.” Another appointee noted the U.S. Digital Service’s certification that the site stayed online for all but 0.01 percent of the 2015 and 2016 enrollment periods.

Now that uptime will drop from 99.99 percent to 92 percent, at best — effectively trimming the open enrollment period by an additional three days.


6. Blocking states from making the ACA work better.

Late in August, President Trump caught wind of an effort to bring more insurers to the Iowa marketplace – an effort requiring approval by HHS. Trump then  called an HHS official and reportedly ordered the department, in no uncertain terms, to say no.

The story was the latest sign of the administration’s intent to block states from seeking leeway to operate their insurance markets. In early October, Oklahoma withdrew a request to implement a plan meant to lower premiums – complaining in a letter that unexplained delays in receiving HHS approval had threatened to disrupt Oklahoma’s insurance market.

Meanwhile, Minnesota Governor Mark Dayton blasted HHS in late September for using its approval of a waiver meant to lower premiums as a pretext to cut $369 million in assistance for lower-income Minnesotans. The move by HHS threatened to reduce, rather than expand, Minnesotans’ access to health coverage.

It’s a grim picture: the officials responsible for helping Americans enroll for health coverage seem bent on ensuring that many people miss their chance to do so.

Key officials from the Obama-era HHS have launched an effort to get clear, no-nonsense information to people eligible for coverage on the marketplaces.


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