Unable to push through a repeal of the Affordable Care Act, president Trump belligerently proclaimed that he would just let it (the “horrible,” “collapsing” Obamacare) “implode” on its own.
Well, not quite. “Explode” is more like it, with the Insane Clown President (journalist Matt Talibbi’s choice term) himself tossing IEDs along the path to enrollment everywhere he can. Among the major sabotaging actions taken to date:
- Drastically reducing advertising for enrollment. In August the administration announced a cut to the advertising budget for open enrollment by 90%, from $100 million to $10 million.
- Shrinking the open enrollment period. The 2018 45-day enrollment period – Nov. 1 – Dec. 15 – is only half the length it was last year. Moreover, the enrollment website will be operational for far fewer hours, especially during busy weekends; Healthcare.gov will be “down for maintenance” for 12-hour blocks on all but one Sunday.
- Pummeling the Navigator programs. Navigator groups in the 34 states using federal insurance marketplaces (because the states didn’t set up their own exchanges) work to link eligible residents with appropriate insurance opportunities, and have been critical to expanding coverage. (Mississippi is one of those 34 states, and the College of Health at USM operates one of those navigator programs, the Mississippi Health Access Collaborative, under a grant, for which I’m co-Principal Investigator.) The total amount of funding for the third year of multi-year grants was cut by the administration – on the day before the new grant year began, no less – by more than 40%. Individual states were cut at various levels (it remains a mystery just what metric the administration used) – some not at all, some as much as 80%, and Mississippi at nearly 60%. As a result, a few navigator groups have shut down entirely; virtually all are having to substantially curtail their consumer assistance activities. (USM’s program suffered a relatively modest cut of under 10%, avoiding staff layoffs, but will still likely need to trim post-enrollment period outreach.)
- Restricting Health & Human Services from supporting local enrollment efforts. In years past, Mississippi navigator grantees have enjoyed visits from HHS staff, promoting collaboration and sharing experiences, developments, and perhaps of most value, encouragement. A similar event was anticipated for this year, until the lead planner, the Mississippi Health Advocacy Program, was notified that no HHS staff would be participating.
- Destabilizing the insurance markets by killing low-income subsidies and authorizing new forms of bare-bones insurance products. This may be the biggest, most destructive bomb of all. The complexities are myriad here, and we won’t try to tackle them in this space. Leave it to cite Mississippi insurance commissioner Mike Chaney, who anticipated Trump’s decision to kill subsidies for low-income enrollees by approving a 47% premium increase for marketplace plans two weeks ago. Chaney guesses that between 5,000 and 10,000 Mississippians will fall out of the federal marketplace as a result. Many more will maintain coverage only at the cost of significant damage to personal and family budgets.
It seems evident that president Trump and the Republican majority in Congress will use every means available to undermine the Affordable Care Act, regardless of consequences for the people affected. When they finally succeed, no doubt the narrative will focus on how bad Obamacare was, how it hurt people, how nobody really wanted it, and that’s why it eventually “imploded.” But that narrative will be then what it always has been – a lie.