Our view: How to kill Obamacare in darkness
The Trump administration does not seem to care that the Affordable Care Act, aka Obamacare, has allowed tens of millions of Americans to purchase health coverage, or that its insurance markets have proved remarkably resilient, or that its popularity has soared since its namesake left office.
Nor is it much impressed by the fact that the basic architecture of the ACA was originally a Republican idea.
No, the Trump administration is determined to kill the program. Having failed to persuade Congress to do the deed, the White House is doing everything in its power to sabotage the law through administrative actions:
❚ Just this month, it announced
90 percent cuts in advertising to encourage participation and 40 percent cuts for “navigator” programs that help consumers sign up, and it stopped
$10 billion in “risk adjustment” payments to medical insurers who accepted the sickest customers.
❚ In June, it reintroduced the concept of slimmed down insurance plans that don’t cover much.
❚ And in April, it changed rules to allow states to cut back on coverage to those with pre-existing conditions.
These regulatory approaches come on top of the administration’s decision not to defend the ACA in a lawsuit brought by 20 conservative state attorneys general, and the Republican tax law’s repeal of the individual mandate.
The common agenda behind each of these actions is to destabilize the insurance markets that the health care law created. The slimmed down coverage, for instance, is likely to attract young and healthy patients who assume that they will never need expensive care. These plans would not only leave them in a lurch should they get sick, the policies would also mean lower insurance revenue to cover older and more expensive patients.
The result will be a death spiral of increasingly large premium increases, draconian copays and less and less competition to serve customers.
While not without flaws, until now the ACA has been a success. It reduced the number of uninsured by 20 million people from enactment to 2016, a time when the overall population grew by 14 million. Obamacare has also played a role in slowing premium increases for employer-sponsored coverage.
So why is the Trump administration stealthily trying to kill Obamacare? Trump and congressional Republicans campaigned on doing just that but were unable to act directly through legislation. Each time they tried, a handful of Republicans balked at killing the program because they had no realistic replacement and didn’t want the blame when millions lost their coverage.
Instead, the Trump administration’s regulatory sabotage approach minimizes accountability that would come from showy votes followed by an Oval Office signing ceremony.
In the end, the result will be the same. Obamacare will have dodged a public execution, but it might die anyway. Republicans should be held accountable for their handiwork — even if it is done in a bureaucratic dark alley instead of openly in Congress.