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Friday, 13 July 2018 05:24

Trump Is Killing the Affordable Care Act by a Thousand Cuts

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obamacare32Trump cuts another slice out of Obamacare. (Photo: LaDawna Howard)

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It is common knowledge that the GOP and Donald Trump have been trying to kill the Affordable Care Act (ACA) through a combination of legislative and executive actions. Although Trump has -- since he first campaigned for the White House -- promised the best insurance and least expensive health insurance system, his and Congress's actions to dismantle the ACA have proven otherwise.

As Vox pointed out in a July 12 article, the GOP's and Trump's efforts in dismantling the ACA are actually increasing premium costs for health insurance by eliminating subsidies to insurance companies and increasing volatility in the marketplace:

Things aren't likely to get any better as the Trump administration keeps rolling back support for the ACA. The law has proved durable, but it has also failed to fully escape peril. Just in the last few weeks, the Trump administration froze critical payments to health insurers while the Justice Department has argued that the law’s protections for preexisting conditions should be ruled unconstitutional in federal court.

The uncertainty fostered by all this in turn drives up insurance premiums, which for 2019 will be finalized in October, shortly before voters head to the polls for the 2018 midterm elections.

Yes, Trump and the Republicans are making health care insurance less accessible, allowing for decreased coverage and creating a more expensive insurance market. As Vox notes in regards to the ACA, "Premiums are still rising by the double digits on average across the country because of Trump's and the GOP's actions."

What is remarkable is that despite these ongoing slashes aimed at Obamacare, the demand remains strong for this year. Last year's enrollment for 2018 remained robust. According to Healthcare Finance,

The Trump Administration has worked to repeal and replace the ACA and CMS [Centers for Medicare and Medicaid Services] cut promotional funds and shortened the open enrollment period.

Despite this, CMS said last year was its most successful open enrollment to date.

It is important to note that the enrollment for 2018 ended before more of the ongoing assaults took place. Therefore, the ACA enrollment at the end of this year will be more of a test of the GOP's effort to shrink Obamacare to non-existence.

An example of an action that has taken place since the last ACA enrollment that will likely have a marked impact on premiums is described in a July article in Healio:

The CMS decision to stop further collections or payments under the risk adjustment program leaves many questions about future health coverage and insurance premiums unanswered, experts and medical associations told Healio Family Medicine.

The action was seen by many as putting another nail in the Affordable Care Act's coffin, which would help the current administration achieve its long sought-after goal of dismantling former President Barack Obama’s signature legislative achievement while raising significant questions for the health care coverage of thousands of patients.

All of these actions have an incremental effect of undermining the ACA.

For example, a July 10 article in The Washington Post announced a second round of Trump administration cuts to groups that assist individuals in enrolling in the ACA:

The Trump administration is eliminating most of the funding for grass-roots groups that help Americans get Affordable Care Act insurance and will for the first time urge the groups to promote health plans that bypass the law's consumer protections and required benefits.

The reduction -- the second round of cuts that began last summer -- will shrink the federal money devoted to the groups, known as navigators, from $36.8 million to $10 million for the enrollment period that starts in November.

Last August, federal health officials announced that they were reducing the navigators' aid by 41 percent, from $62.5 million, and slashing by 90 percent a related budget for advertising and other outreach activities to foster ACA enrollment.

Of this meager amount of funds assigned to help in ACA sign-ups, the Trump administration is giving preference to offering grants to groups that push bare-bones and short-term health insurance that does not include the consumer protections -- including an exemption from pre-existing conditions -- offered in the original ACA. These are known as "skinny" insurance policies. They pull people with limited incomes out of the ACA plan, as well as attract younger, healthier enrollees. This has the impact of raising the ACA and general health insurance rates for individuals who need comprehensive coverage. The catch is that the coverage on these plans is reduced from original ACA requirements. It is also likely that this strategy will increase the number of under- and uninsured Americans.

The downward adjustment in subsidizing groups to help people select the best ACA plan for them, along with a new emphasis on such organizations assisting people to find less comprehensive plans that leave them more vulnerable to uncovered health care costs, is one small example of how the Trump administration is intractably attempting to destroy Obamacare.

The Trump administration is killing the ACA by a thousand cuts. The cumulative impact will increase the number of uninsured Americans and push others into policies that do not cover many expensive health care needs.