Sup­port­ers fear ACA set up to fail

The Arizona Republic - - USA Today -

trac­tive, 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 in­di­vid­ual man­date and sub­si­dies is the big­gest rea­son for com­pa­nies rais­ing prices.

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