After several failed attempts to repeal the Affordable Care Act (ACA), and with more immediate priorities looming, Congress has decided to shift focus, at least for now. President Trump believes he can force their hand and precipitate the ACA’s collapse by refusing to enforce parts of the law – at the expense of those who rely on it for health care.
In June, Anthem, Inc. and MDwise Marketplace announced they were pulling out of the Indiana marketplace. In public statements, both insurers cited market uncertainty as a key driver in their decision.
According to Anthem, “The Individual market remains volatile, making planning and pricing for ACA-compliant health plans increasingly difficult due to a shrinking and deteriorating market as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage.”
Trump’s ill-fated strategy includes a poorly-defined conception of what it means for the ACA to fail. The individual marketplaces are not a monolithic entity that will rise or fall together. This is not to suggest that the actions of the president and Congress have no impact. In struggling marketplaces, a threat by the president not to enforce the purchasing mandate will translate into fewer healthy enrollees signing up, making the insurance pools sicker and pushing premiums higher for everyone.
Compounding that problem, the Trump administration plans to cut the ACA’s advertising budget by 90% compared to last year – from $100 million to $10 million. To put that in perspective, California is planning to spend $111 million on ACA advertising in its state alone. Trump also plans to cut in-person outreach by 40%. This is in addition to cutting the open enrollment period in half from 90 to 45 days.
Trump has also given insurers the runaround for months on whether he will eliminate cost-sharing reduction (CSR) payments. According to the Congressional Budget Office, this would contribute to double-digit premium increases in the short-term as insurers absorb what amounts to $7 billion this year. Eliminating CSRs would also add $194 million to the budget over ten years.
According to a recent report from the Kaiser Family Foundation that examined proposed filing rates for insurers in several states, Indiana’s premiums are set to increase in 2018 after three years of decline. Both Centene and CareSource – the two remaining insurers in Indiana – indicate this increase does not reflect a loss in CSRs and would rise more if Trump decides to end them.
The cure to what ails struggling marketplaces is enticing more healthy people to enroll. Some ways to achieve this include greater promotion and outreach, longer enrollment periods and greater cost-sharing – the exact opposite of what Trump is doing.
Unpopular, and with few achievements to hang his Make America Great Again hat on, the president is willing to jeopardize health care for millions of Americans who rely on the ACA. He promised a repeal on day one without a clue about the legislative process or health care in particular, and now that it’s buried beneath a stack of other legislative priorities, he plans to use it against Republicans in Congress to deflect blame from his own broken promises.
It’s a strategy that will not serve him well during the mid-term elections next year, where a democratic majority in either chamber could rain disaster on the latter half of his presidency. At some point, the “outsider” candidate must either prove he can fix the gridlock in Washington, or else be the most recent in a line of politicians who failed to live up to their campaign slogans.
Jenny Sue Kakasuleff is a former political campaign manager and staff member at the Indiana House of Representatives. She is a communications professional and freelance writer who has covered politics and policy issues at NUVO Magazine and Huffington Post. Follow Jenny on Twitter: @libgrrrl.