Next: President Donald Trump still controls the fate of Obamacare.
Administration can shore up ACA or let it atrophy
WASHINGTON» Although House Speaker Paul Ryan, R-Wis., acknowledged Friday that “Obamacare is the law of the land,” its survival or collapse in practical terms now rests with decisions that are in President Donald Trump’s hands.
In the coming weeks and months, the White House and a highly conservative Health and Human Services secretary will be faced with a series of choices over whether to shore up insurance market places created under the Affordable Care Act — or let them atrophy. These marketplaces are a conduit to health coverage for 10 million Americans, but they have been financially fragile, prompting spiking rates and defections of major insurers.
In the seven years since a Democratic Congress passed the law, public sentiment over it has been closely divided. Support has grown slightly in recent months.
There are many levers within the ACA that the Trump administration could use to undermine the law or, instead, try to stabilize its marketplaces. In addition, federal rules could be redefined, giving the government’s health policies a more conservative twist even with the law still in effect.
According to health care experts from across the ideological spectrum, an imminent question is whether the political tumult surrounding the ACA’s fate and the president’s talk of explosion could further shake the confidence of consumers and insurers alike. Doing so could prompt exits from the marketplaces.
The decisions facing the administration are, in essence, a sequel to an executive order the president issued his first night in office, when he directed federal agencies to ease the regulatory burden that the ACA has placed on consumers, the health care industry and health care providers. So far, the main action stemming from that directive is a move by the Internal Revenue Service to process Americans’ tax refunds even if they fail to submit proof that they are insured, as the ACA requires.
But there are other steps the administration could take. A major one would be to end cost-sharing subsidies the law provides to lower- and middle-income people with marketplace plans to help pay their deductibles and co-pays.