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Behind the Scenes, President Trump Is Still Working to Dismantle Obamacare

Aug 14, 2017

Efforts to repeal and replace Obamacare may have fizzled in Congress — at least for now — but President Donald Trump is doing plenty to undermine the health care law as open enrollment approaches this fall.

Much of this involves measures that the Trump administration isn’t taking to support the law. The administration hasn’t publicly committed to continuing the government payments that lower deductibles and other costs for lower-income enrollees, leading some insurers to request premium hikes of up to 23% to compensate for the uncertainty, according to a study last week by the Kaiser Family Foundation. What’s more, Talking Points Memo reported Monday that the Department of Health and Human Services is cutting ties with organizations that helped promote open enrollment among gig economy workers, youth groups and others.

The Trump administration is weakening the Affordable Care Act, also known as Obamacare, through this neglect, experts say. “It actually takes a lot of behind-the-scenes infrastructure to just to keep these things operational,” says Sabrina Corlette, research professor at the Center on Health Insurance Reforms at the Georgetown University Health Policy Institute. The Obama administration poured resources into this infrastructure, while the Trump administration has not.

The President has tweeted that Obamacare is imploding, but his actions — or rather, inaction — has contributed to an environment where some insurers are exiting the marketplaces and those remaining are raising premiums. The Kaiser report noted that “this policy uncertainty is far outside the norm.”

Premium rates for 2018 haven’t been finalized yet, but preliminary filings show insurers that assumed that the cost-sharing payments would be discontinued have applied to the states for an additional rate increase of between 2% to 23%, according to the report. The reason insurers would need to raise rates is that they’d lose revenue if the government is no longer making payments to them to lower costs for their lower-income enrollees.

There’s also uncertainty about whether the Trump administration will enforce the individual mandate, the Obamacare provision that most people must buy insurance or pay a penalty at tax time. The law’s success depends on a big pool of enrollees, with plenty of young, healthy people to subsidize the older, sicker ones. (This is how insurance works generally — just as homeowners lucky enough to escape fires or robberies subsidize those who have not been so fortunate, people fortunate enough to remain healthy subsidize those with devastating diagnoses or age-related aliments.)

The individual mandate was designed to ensure a big enrollment pool. The various bills proposed by House and Senate to replace Obamacare would have repealed it. While it remains on the books, if it’s not enforced then fewer people will sign up for coverage. Insurers assuming the individual mandate will not be enforced have built into their rate increases an additional 1.2% to 20%, according to the Kaiser report.

Also, fewer people will sign up for coverage if they’re not aware of when open enrollment is happening. Open enrollment for 2018 coverage is scheduled to run from Nov. 1 to Dec. 15, a full six weeks less than last year’s open enrollment period, after the Trump administration shortened the duration earlier this year.

The Obama administration partnered with companies like Uber and TaskRabbit last year to spread the word on open enrollment — on top of existing relationships the administration had with non-profit organizations for the same purpose — but there’s been no sign those partnerships will continue, Talking Points Memo reported.

"A lot of people are procrastinators,” says Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, and one of the authors of the report. “If there’s less information and less marketing, people may not realize they need to sign up sooner this year, and they could miss their window."

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