White House sends mix­ture of mes­sages

Next step un­clear as in­sur­ance bat­tle en­ters new stage

The Denver Post - - NEWS - By Ri­cardo Alonso-zaldivar and Ken Thomas

WASH­ING­TON» — Re­peal and re­place Oba­macare. Just re­peal. Or let it fail — maybe with a lit­tle nudge. Pres­i­dent Don­ald Trump has sent a flurry of mixed mes­sages, rais­ing ques­tions about the White House strat­egy on health care.

Democrats say Trump’s con­fus­ing sig­nals are part of a strat­egy to desta­bi­lize the Af­ford­able Care Act, as a way to force re­cal­ci­trant Repub­li­cans in Congress to re­peal for­mer Pres­i­dent Barack Obama’s sig­na­ture law.

White House of­fi­cials say they re­main fo­cused on try­ing to get a bill passed and have de­clined to delve deeply into their health care op­tions if leg­is­la­tion fails.

“The White House does not have a strat­egy,” said health in­dus­try con­sul­tant Robert Laszewski, an Oba­macare critic who be­lieves the ad­min­is­tra­tion is at a loss.

An­other the­ory: Trump may have to cut his losses and take mod­est steps to sus­tain sub­si­dized in­sur­ance mar­kets if the GOP’S leg­isla­tive drive fails. A Se­nate vote is planned Tues­day.

Iron­i­cally, in­sur­ance mar­kets don’t ap­pear to be on the verge of col­lapse as Trump and other Repub­li­cans keep say­ing. About 10 mil­lion peo­ple have in­di­vid­ual poli­cies un­der that part of Oba­macare.

“Im­prov­ing but frag­ile” is how Stan­dard & Poor’s an­a­lyst Deep Banerjee de­scribes the in­sur­ance ex­changes. “We ex­pect on av­er­age for in­sur­ers to hit break even” in 2017.

And Obama’s Med­i­caid ex­pan­sion — which pro­vides cov­er­age to an­other 11 mil­lion — is un­af­fected by prob­lems on the ex­changes.

Sen. Ron Wy­den, D-ore., who has pre­vi­ously worked with Repub­li­cans on health care, sees a White House bent on mis­chief.

“They are do­ing ev­ery­thing they can to stoke the fires of un­cer­tainty, which is what re­ally dam­ages this law,” Wy­den said. “You can say, ‘I’d like to change the law,’ but you don’t just say, ‘We’re go­ing to do ev­ery­thing in our power to un­der­mine a law that is on the books.’ This is about be­ing will­ing to hurt peo­ple in order to get a po­lit­i­cal ad­van­tage, and I’ve never seen a pres­i­dent do­ing it in such a brazen way.”

The Trump ad­min­is­tra­tion says what’s re­ally hurt­ing peo­ple is higher pre­mi­ums and dwin­dling choice un­der Oba­macare. Some ma­jor in­sur­ers have bailed out or scaled back their of­fer­ings on the ex­changes, leav­ing many con­sumers with limited op­tions.

But Democrats cite the ad­min­is­tra­tion’s pull­back of open en­roll­ment ads early this year as ev­i­dence of “sab­o­tage,” along with the re­cently dis­closed ter­mi­na­tion of fed­eral con­tracts for sign-up as­sis­tance in 18 cities. Also, the 2018 en­roll­ment sea­son has been short­ened to 45 days, about half the time pre­vi­ously pro­vided.

And the Health and Hu­man Ser­vices De­part­ment has posted in­ter­net videos of small-busi­ness own­ers blam­ing high in­sur­ance costs on Oba­macare. Those videos are “im­por­tant and ed­u­ca­tional tes­ti­mo­ni­als” that show the ACA has made af­ford­able in­sur­ance “im­pos­si­ble for mil­lions of Amer­i­cans,” said agency spokes­woman Alleigh Marre.

It def­i­nitely looks like a hos­tile takeover, said econ­o­mist Joe An­tos of the busi­ness-ori­ented Amer­i­can En­ter­prise In­sti­tute, “but usu­ally with a hos­tile takeover, there is a busi­ness ob­jec­tive that is rel­a­tively clear.”

Laszewski, the con­sul­tant, put it this way: “First, it was the Democrats will come beg­ging (Trump) to fix it. Then it was re­peal and re­place, then it was just re­peal, and now it is re­peal and re­place again.”

The most im­me­di­ate ques­tion is whether the Trump ad­min­is­tra­tion will con­tinue monthly pay­ments to in­sur­ers on sub­si­dies that re­duce de­ductibles and co­pay­ments for con­sumers with mod­est in­comes. “Cost-shar­ing re­duc­tions” to­tal $7 bil­lion a year.

The pay­ments are em­broiled in a law­suit brought by House Repub­li­cans over whether the ACA specif­i­cally in­cluded a con­gres­sional ap­pro­pri­a­tion for the money, as re­quired un­der the U.S. Con­sti­tu­tion. Else­where, the ACA text plainly says the gov­ern­ment “shall” make the pay­ments. But Trump re­cently sug­gested to he might just stop.

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