Piece by piece, Trump tries to un­ravel Oba­macare

Pres­i­dent acts on his own af­ter fail­ures in Con­gress

Chicago Sun-Times - - NATION - Heidi M. Przybyla and Jayne O’Don­nell USA TO­DAY

When it comes to health care, Pres­i­dent Trump says he’s do­ing “the right thing” for Amer­i­cans. He’s will­ing to work with Democrats on a bi­par­ti­san plan, he says, af­ter three failed at­tempts by the Re­pub­li­can- con­trolled Con­gress to re­peal and re­place the Af­ford­able Care Act

At the same time, he’s us­ing the power of the pres­i­den­tial pen to un­ravel the ACA piece by piece — which could af­fect health care cov­er­age for more than 11 mil­lion Amer­i­cans.

Trump took his most con­crete step to dis­man­tle the ACA on Thurs­day, when he signed an ex­ec­u­tive or­der that would al­low in­sur­ers to sell short- term plans that don’t meet ACA guide­lines.

“Since I be­came pres­i­dent of the United States, I just keep hear­ing ‘ re­peal and re­place, re­peal and re­place.’ Well, we’re start­ing that process,” Trump said, promis­ing the or­der would be the first of many steps.

Un­der the or­der, con­sumers could pur­chase short- term health plans that would cover peo­ple for up to a year as part of as­so­ci­a­tions of small busi­nesses or in­di­vid­u­als and across state lines.

ACA sup­port­ers are con­cerned that if Oba­macare al­ter­na­tives are made more avail­able and at­trac­tive, they’ll lead to the kind of bare- bones poli­cies the Af­ford­able Care Act out­lawed. If young, healthy con­sumers help­ing to sub­si­dize older, sicker pa­tients pull out of state ex­changes, that will re­sult in even higher pre­mi­ums for the Oba­macare plans.

The ad­min­is­tra­tion has re­fused to com­mit to pay­ing in­sur­ance com­pa­nies sub­si­dies to re­duce the cost of buy­ing in­sur­ance for Amer­i­cans who don’t make much money. There is un­cer­tainty about whether the govern­ment will con­tinue to re­quire peo­ple to buy in­sur­ance or pay a penalty on their taxes.

In­sur­ance com­pa­nies could raise the cost of in­sur­ance for those who can pay. If the com­pa­nies can’t find the money to break even on their ex­penses, they could stop sell­ing in­sur­ance in parts of the coun­try.

Trump halved the time in which peo­ple can buy health in­sur­ance, start­ing Nov. 1, and cut the na­tional ad­ver­tis­ing bud­get and grants for “nav­i­ga­tors,” who help show peo­ple how to buy in­sur­ance. The fed­eral web­site used to buy in­sur­ance for 39 states will be closed for main­te­nance for up to 12 hours ev­ery Sun­day, a peak shop­ping day.

“It’s hard to look at that se­ries of de­ci­sions, which is en­tirely in the hands of the ad­min­is­tra­tion, and say they want any­thing other than this to be a mis­er­able fail­ure,” said Kath­leen Se­be­lius, Obama’s first Health and Hu­man Ser­vices sec­re­tary.

Trump said his or­der will make cheaper health in­sur­ance avail­able to more con­sumers. It will give self- em­ployed peo­ple who earn more than 400% of the fed­eral poverty limit — about $ 65,000 for a fam­ily of two — a chance to buy in­sur­ance that doesn’t cover things they don’t want. Many women past child­bear­ing age, for in­stance, have com­plained about hav­ing to buy plans that cover child­birth, said Gail Wil­len­sky, who headed the Cen­ters for Medi­care and Med­i­caid Ser­vices un­der Pres­i­dent Ge­orge H. W. Bush.

The or­der will cut the mar­ket in pieces, said Eliot Fish­man, se­nior di­rec­tor of health pol­icy at Fam­i­lies USA, which sup­ports the ACA. Peo­ple who need more ex­pen­sive cov­er­age will be forced into one mar­ket, while those who don’t want to buy it will go into an­other mar­ket. That would un­der­mine the en­tire sys­tem, which de­pends on young, healthy peo­ple pay­ing to off­set the costs of in­sur­ing those with var­i­ous med­i­cal con­di­tions.

Trump could help sta­bi­lize the mar­ket and lower likely pre­mium in­creases by guar­an­tee­ing to pay the sub­si­dies that in­sur­ers use to cut out- of- pocket costs for cus­tomers. He could em­pha­size that the In­ter­nal Rev­enue Ser­vice is en­forc­ing the law re­quir­ing those who don’t buy in­sur­ance to pay the tax penalty.

The ad­min­is­tra­tion de­cides each month whether to pay the sub­si­dies. A re­port on in­sur­ance rates in 20 states by the non- par­ti­san Kaiser Fam­ily Foun­da­tion found that un­cer­tainty about the man­date and sub­si­dies is the big­gest rea­son for com­pa­nies rais­ing prices.


Pres­i­dent Trump is­sued an ex­ec­u­tive or­der on health care plans.

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