Semro column: Health care — aiming for the iceberg
When it comes to health care, observing the actions of this administration is a bit like watching the captain of the Titanic steering straight for the iceberg.
The president keeps saying that the Affordable Care Act is imploding. That assertion is highly debatable at best. But what’s not debatable is that this administration is doing everything possible to damage the ACA through funding reductions, regulatory hurdles and executive orders, regardless of the damage those actions will leave in their wake.
Since inauguration, the Trump administration, which is charged to faithfully execute the laws of the land, has been doing the exact opposite when it comes to health care. In January, the Department of Health and Human Services removed information from its website to help consumers obtain coverage through the ACA’s health insurance marketplaces. This included removing links to benefit summaries, emergency services and doctor choice. It also removed any positive references about the law, including testimonials from Americans who had benefited from it.
In February, the administration weakened the enforcement of the individual mandate that’s designed to encourage Americans to purchase coverage rather than pass the cost of their care on to hospitals and other Americans that have insurance. Enforcement of the mandate is the responsibility of the Internal Revenue Service. And this year the IRS stated that it would process tax returns even if taxpayers failed to indicate whether they had coverage.
This summer, HHS began producing videos openly attacking the law. By August, the administration had cut funding for open enrollment advertising and promotion by 90 percent. In that same month, it cut funding in half for health insurance navigators, who assist consumers in the insurance marketplaces. The next ACA open enrollment period will be reduced from three months to six weeks, giving consumers less time to sign up for coverage. The department intends to shut down the healthcare.gov website for 12 hours every Sunday.
This month an executive order was signed to allow the sale of limited-benefit plans across state lines that will start a race to the bottom in terms of coverage, drive up premium costs for more comprehensive plans, as well as allowing plan providers to sidestep state regulations and solvency protections. According to the Colorado Division of Insurance, this executive order “will fracture the individual and small group [small employer] markets.”
And now we see the administration’s most flagrant attempt to promote market uncertainty and scuttle the law.
The latest decision to defund Cost Sharing Reduction Payments that 6 million Americans depend on for their health and well-being is a manufactured crisis that was completely avoidable. The administration claims that CSRs are unlawful because of a lower court ruling that held that the administration can’t reimburse insurance companies for their obligation under the ACA to reduce cost sharing for low income policy holders, because Congress hadn’t “specifically” appropriated money for that purpose.
First of all, this lower court ruling doesn’t constitute settled law or require immediate action on the part of this administration. Secondly, Congress could “specifically” appropriate the money in a couple of weeks, if health-care reform hadn’t been turned into a political dog bone.
It’s not a massive expenditure. CSRs would cost $7 billion in 2017 and $10 billion in 2018. In contrast, according to the Congressional Budget Office, removing CSRs would actually add $194 billion to the deficit over 10 years. And by the way, since CSRs are designed to reimburse insurers only for cost sharing reductions going to poorer Americans. They don’t add to the bottom line of those companies. So it’s hardly corporate welfare.
According to the CBO, defunding CSRs could increase premiums for the most popular types of plans by 20 percent in 2018 and by an extra 25 percent in 2020. Without CSRs, more insurers will leave the market, especially in rural areas like ours and health insurance will become ever more unaffordable for those who need it most. Colorado’s insurance commissioner calls the administration’s decision “cruel and irresponsible” and adds that “it doesn’t help people and will actually hurt consumers.”
On Tuesday, Sens. Lamar Alexander, R-Tennessee; and Patty Murray, D-Washington; reached an agreement on a bipartisan approach to stabilize the individual insurance market that includes funding for CSRs. If Congress were to act and if the administration supports the final agreement, the long-term damage could be at least be delayed.
In terms of politics, health care is the most personal and consequential of issues. According to the latest Kaiser Family Foundation poll, 70 percent of Americans want the president to make the ACA work instead of making it fail.
But the president has said, “I’m not going to own it. I can tell you the Republicans aren’t going to own it. We’ll let Obamacare fail.” Well, Capt. Smith didn’t own the Titanic, but he still went down with the ship.
Bob Semro of Glenwood Springs is a former health policy analyst for the Bell Policy Center, and a legislative and senior advocate.