HAVING FAILED in their effort to repeal the Affordable Care Act outright, the Trump administration and the Republican Congress are now waging a piecemeal assault on Barack Obama’s most significant domestic accomplishment. They have, of course, proclaimed its demise time and time again. But all that 2017 talk about how the law had failed or was starting to fail was just so much blather designed to justify their repeal efforts.
However, the GOP’s multi-front assault on the ACA now appears to be having some effect. Last fall, the Trump administration ended the cost-sharing-reduction payments designed to help offset copayments and deductibles for low-to-moderate earners. That roiled the insurance markets. The administration also slashed the advertising and outreach efforts that encourage people to sign up for plans during the ACA enrollment period. The fewer healthy enrollees, the higher the plan premiums.
Then, as part of its tax cut legislation, passed on a party-line vote, the Republican Congress nixed the penalty for individuals who fail to buy health coverage, starting in 2019. Without a penalty, the requirement is toothless. (The mandate is hardly the only, or even principal, reason that people bought health care under the ACA; 90 percent of those polled earlier this spring by the Kaiser Family Foundation said they planned to buy insurance next year despite its de facto repeal.)
Meanwhile, the administration is finalizing regulations for short-term health insurance plans; because they needn’t meet ACA coverage requirements, those skimpier plans will be cheaper, and thus may lure younger and healthier people from broader but more expensive ACA-compliant plans. And when it comes to having a sufficiently large risk pool to spread costs widely enough to keep premiums affordable, relatively small percentages can matter.
According to the Commonwealth Fund, another nonprofit that specializes in health care policy, the rate of working-age people without insurance has gone from 12.7 percent in 2016 to 15.5 percent today. That means about 4 million fewer people are covered. The Fund also found that 9 percent of those currently covered in the individual insurance markets say they won’t buy coverage next year. Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, notes that insurers are already citing the pool-depleting effects of impending short-term plans in order to justify price hikes for next year’s ACA-compliant coverage.
Meanwhile, congressional efforts to stabilize the insurance pools, either by re-establishing cost-sharing subsidies or helping states set up reinsurance plans to offset costs of the most expensive patients, have gone nowhere. Given the reflexive hostility Trump and congressional Republicans have for all things Obama, it’s hard to see these issues getting worked out while Republicans retain control of both houses of Congress and the presidency.
But rising insurance premiums are likely to be an issue in the fall congressional campaigns. Voters who support the ACA need to hold the proper party responsible for the intentional slow-motion, beneath-the-radar screen effort to gum up the law’s works. And make no mistake, that’s the GOP.