Republicans’ Insidious Undermining of the Affordable Care Act
Newly-elected Donald Trump asserted that the Affordable Care Act (ACA) would be repealed on day one of his administration. Ten months and numerous close votes later, the ACA remains the law of the land. Nonetheless, the Trump administration and its Republican allies in Congress have been relentless in their efforts to destroy the Act from within, and all of us who support health insurance access at reasonable cost cannot let them go unchallenged. Their strategy is sophisticated and multifaceted. And Republicans in Washington and in Virginia have been complicit with this strategy by their deafening silence.
If You Can’t Win The Votes, Sabotage the Market
Trump’s consistent threat to withhold the subsidies (CSRs) which allow insurance companies to keep premium increases to a minimum became reality last week with his Executive Order. The result should surprise no one; faced with unpredictable markets and increasing costs, health insurance companies will either abandon offering coverage or increase premiums to cover their risk. The no-subsidy threat alone has had serious effects. In Virginia, for example, Anthem pulled out of the marketplace in August, leaving more than 60 jurisdictions with no insurer offering coverage. It was only after intense political pressure from Gov. McAuliffe and others that Anthem jumped back in, but premiums are expected to rise. Now that the administration is definitely reneging on federal payments, the reality will be devastating. Some 240,000 Virginians bought health insurance supported by ACA-mandated subsidies; their costs will rise and some will simply not re-enroll, thereby creating a so-called “death spiral” in the markets.
If You Don’t Like The Program, Cut Enrollment Opportunities
Trump and his allies also hope to reduce enrollment in the ACA so they can point to this “alternative fact” as proof that the system is collapsing. They cut the advertising budget to remind the public about open enrollment by 90 percent, then reduced the window to enroll by one-half—from 12 weeks to only 6 weeks. And then they cut into public access even more:
Do not be surprised, then, when the number of uninsured Americans increases in the new year. And since the program works better financially when greater numbers are insured, the economic pressure on the market and its remaining participants will only increase. The administration’s rationale for these changes was lack of money—ironic in light of the recently-resigned HHS Secretary’s costs in taking private jets to various meetings.
If You Dislike the Law, Don’t Enforce It
Trump has also said that his administration will not enforce the penalties that underpin the individual mandate, providing another incentive for citizens to go without coverage and undermine the system as a whole. The ACA system works better when the insurance pools expand, and the risks are spread across larger numbers of Americans.
If a Program Is Successful, Let It Expire and Create “Junk Plans” with Fewer Benefits
The administration and Republican Congress recently failed to reauthorize the Children’s Health Insurance Program (CHIP), a very successful program bringing health care to 9 million Americans, including 65,000 children and 1,100 pregnant mothers in Virginia. Like so many of Washington’s actions, this will have a serious impact on our Virginia budget as we try to find a way to continue covering our neighbors who receive CHIP; estimates for doing this without a federal contribution run as high as $80 million during just the next biennium. And the President is now promoting insurance plans with higher deductibles that may not offer the essential health benefits offered by plans on the marketplace, in hopes that consumers will withdraw from ACA-compliant plans and further undermine their financial viability.
If You Won’t Solve a Problem, Prevent the States from Doing So
Trump and his allies talk a good game about empowering states to solve their own problems, but then balk when asked to approve unique approaches. The state of Iowa recently sought permission, through a provision in federal law that allows states to adjust how the ACA works in an individual state (a “section 1332 waiver”), to fix their challenged marketplace. The ACA allows such waivers to be approved so long as the proposed change would not eliminate or provide less affordable coverage to citizens in an individual state. Trump took offense to the proposal, even though it included the type of tax credits Republicans were promoting in DC, and actively worked to scuttle the plan.
What’s Next—The Personal
Enrollment in the ACA exchanges begins November 1 and ends December 15.
If you or others you know need help with this process, contact the Legal Aid Justice Center at 434-220-1496 or the Jefferson Area Board for Aging (JABA) at 434-817-5248. Don’t delay.
What’s Next—The Political
In the next few weeks, there will be more and more headlines about increases in health insurance premiums and how this proves the failure of “Obamacare.” Resist this narrative! Washington has the power to address the problems in the marketplace, but Trump and his allies want the system to collapse. Rhetoric aside, they now own the problem and we need to let our friends and neighbors know it.
The election for Governor, Lt. Governor, Attorney General and all 100 members of the House of Delegates is November 7, and your vote can send a clear message that Trump’s policies (supported by Republicans in Congress) are heartless and fiscally irresponsible. The best way to do that is to vote for Ralph Northam, Justin Fairfax, Mark Herring, and Democratic incumbents and challengers in House of Delegates races. Not only will that be viewed as a statement against the partisan attempts in Washington to sabotage our health care system’s security, but a Northam administration will understand better how to address the state challenges that flow from the federal attacks. To combat these issues, Virginia will likely need to think about creative ways to shore up the state’s insurance marketplace. One option would be to request, as did Alaska recently, partial federal funding to create a reinsurance fund. Medicaid expansion would, of course, help greatly, but that will not solve all the problems inherent in making Virginians healthier and more economically secure. Trump has made challenges for Virginians immense, and the only way for us to solve them is by electing people who show they understand and have the energy and compassion to get things done.