Americans show they care
The Trump administration’s boundless determination to destroy President Barack Obama’s health care reform appears to be matched only by Americans’ eagerness to sustain it. Even as the president and his allies in the Senate considered yet another attack on the Affordable Care Act, insurance enrollments under the law were mounting at a record pace.
President Trump’s reckless position on the subject was capably summarized by his budget director, Mick Mulvaney, who told CBS’s “Face the Nation” that the White House “would love to see Obamacare taken apart all at once, bit by bit — however we can do it.” Mulvaney was responding to a possible repeal of the crucial ACA insurance mandate being considered as part of tax cut legislation in the Senate, which has repeatedly tried and failed to undo the health care law.
The first three weeks of continuing ACA enrollments, meanwhile, saw nearly 2.3 million people sign up for insurance through HealthCare.gov — the federal marketplace used by the 39 states that don’t have their own exchanges — more than a week ahead of last year’s pace. That was despite the Health and Human Services Department’s blatant efforts to suppress participation by cutting marketing by more than 90 percent, reducing enrollment assistance by more than 40 percent, and even shutting down the HealthCare.gov website for parts of most weekends during the signup period. The administration also has halved the duration of the enrollment period, which will limit participation even if it proceeds at an unprecedented rate.
Covered California was also seeing a record response. The state exchange, which has maintained a longer signup period and increased marketing to make up for the federal reductions, reported a 23 percent increase in new enrollments at the two-week mark compared with last year.
If the Senate uses tax legislation to rescind the insurance mandate (which takes the form of a tax penalty for those who do not obtain coverage), more largely healthy Americans would likely risk going without coverage, causing premiums to go up as insurers are forced to cover a generally sicker and more costly insured population. Though the Congressional Budget Office has estimated that the federal government could thereby save $388 billion in insurance subsidies, reducing the nominal cost of the tax bill, it would be at the expense of 13 million more uninsured.
Since the House narrowly passed a partial ACA repeal in May, the Senate has tried and failed to pass five major bills to reverse or roll back the law. Trump has tried to do the same by fiat, eliminating funding to stabilize the insurance marketplaces, signing an executive order to encourage low-coverage plans that circumvent ACA standards, and flatly (and falsely) declaring that the law no longer exists.
In that light, the public embrace of the Affordable Care Act amounts to a stark rejection of administration and Republican policy. Even Mulvaney seemed to understand as much, saying Trump would not insist that the tax bill include the repeal provision. The Senate should seize the opportunity to avoid another failure and heed the will of the people.