Piece by piece, Trump tries to unravel Obamacare
President acts on his own after failures in Congress
WASHINGTON When it comes to health care, President Trump says he’s doing “the right thing ” for Americans. He’s willing to work with Democrats on a bipartisan plan, he says, after three failed attempts by the Republican-controlled Congress to repeal and replace the Affordable Care Act.
At the same time, he’s using the power of the presidential pen to unravel the ACA piece by piece — which could affect health care coverage for more than 11 million Americans.
Trump took his most concrete step to dismantle the ACA on Thursday, when he signed an executive order that would allow insurers to sell short-term plans that don’t meet ACA guidelines.
“Since I became president of the United States, I just keep hearing ‘repeal and replace, repeal and replace.’ Well, we’re starting that process,” Trump said, promising the order would be the first of many steps.
Under the order, consumers could purchase short-term health plans that would cover people for
“I just keep hearing ‘repeal and replace, repeal and replace.’ Well, we’re starting that process.” President Trump
up to a year as part of associations of small businesses or individuals and across state lines.
ACA supporters are concerned that if Obamacare alternatives are made more available and at-
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-ofpocket 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.