An act of sab­o­tage against the ACA

The pres­i­dent’s ex­ec­u­tive or­der might dev­as­tate the mar­ket­places.

The Washington Post - - WASHINGTON FORUM -

PRES­I­DENT TRUMP on Thurs­day signed an ex­ec­u­tive or­der di­rect­ing his ad­min­is­tra­tion to ramp up its sab­o­tage cam­paign against the Af­ford­able Care Act, also known as Oba­macare, also known as the health-care law with­out which mil­lions of needy peo­ple would lack cov­er­age.

The only good news is that the or­der merely in­structs ex­ec­u­tive agen­cies to draw up some new, looser reg­u­la­tions, rather than im­me­di­ately erod­ing Oba­macare’s pro­tec­tions. The bad news is that those looser reg­u­la­tions may nev­er­the­less come soon, and they could dev­as­tate the ACA’s care­fully reg­u­lated mar­ket­places. Much de­pends on how reck­less the lead­ers of agen­cies such as the La­bor Depart­ment de­cide to be.

Oba­macare’s un­der­ly­ing logic is that cover­ing peo­ple who get sick or are likely to be­come sick, be­cause of their age or pre­ex­ist­ing con­di­tions, re­quires a big in­sur­ance pool with enough healthy peo­ple to spread risk evenly. Repub­li­cans have ar­gued that this sys­tem is un­just to the healthy and young, who pay more into the sys­tem than they get out of it, and that they can ad­just the sys­tem to fa­vor the for­tu­nate with­out harm­ing the un­lucky. They are wrong, as anal­y­sis af­ter anal­y­sis of their var­i­ous health-care bills showed. That is one rea­son GOP law­mak­ers failed to pass the bills. Not tak­ing the hint, Mr. Trump is now try­ing to un­der­cut Oba­macare’s in­sur­ance pool by ex­ec­u­tive fiat, sidestep­ping Con­gress.

The pres­i­dent’s ex­ec­u­tive or­der in­structs the La­bor Depart­ment to re­write rules on health-care plans that small busi­nesses can band to­gether and buy into. In­stead of be­ing reg­u­lated like other Oba­macare in­sur­ance plans, th­ese as­so­ci­a­tion health-care plans would po­ten­tially not have to cover a slate of es­sen­tial ben­e­fits. The plans could be cheaper but also use­less for sick peo­ple. Also, in­sur­ers might be able to charge small em­ploy­ers much more for plans if they have older or sicker em­ploy­ees.

The re­sult is that healthy peo­ple would end up cov­ered with cheap and scanty as­so­ci­a­tion plans while sick peo­ple were left in the nor­mal Oba­macare mar­ket that guar­an­tees them needed ben­e­fits. Pre­mi­ums for those sick peo­ple then would sky­rocket. The dam­age would be pro­found if the La­bor Depart­ment con­cluded that in­di­vid­ual in­sur­ance cus­tomers could buy into plans meant for small as­so­ci­a­tions. Then many healthy in­di­vid­u­als would exit Oba­macare’s big in­sur­ance pool.

The pres­i­dent’s plan to en­hance sup­pos­edly short­term in­sur­ance poli­cies is sim­i­larly dan­ger­ous. Meant as stop­gap in­sur­ance for peo­ple between jobs, th­ese plans are al­most to­tally un­reg­u­lated — so they can be cheap, skimpy and fairly use­less for sick peo­ple — but they can run only for three months. Mr. Trump’s ex­ec­u­tive or­der could al­low them to run for 364 days in a year, en­abling healthy peo­ple to use skimpy plans as their pri­mary health-in­sur­ance poli­cies. Once again, this would pull healthy peo­ple out of the Oba­macare pool and into cheap, sub­stan­dard plans, trig­ger­ing a dis­as­trous es­ca­la­tion in costs for those left be­hind in the ACA in­sur­ance pool.

Mr. Trump con­stantly crit­i­cizes Oba­macare’s ris­ing pre­mi­ums. If his ex­ec­u­tive or­der is fully im­ple­mented, those pre­mi­ums will rise a lot more — es­pe­cially for some of the Amer­i­cans who need help the most.

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