These are the steps the Trump administration is taking to undermine the ACA

[cigaretteman]

Our Asshole in Chief hard at work to deprive Millions of Americans of affordable healthcare:

President Trump issued an executive order on Thursday, Oct. 12th allowing some people to buy cheaper, less comprehensive insurance plans than those offered on the Affordable Care Act marketplaces. Because it could prompt some healthy consumers to drop their marketplace plans, which would alter the overall risk pool, experts characterize this as one of many efforts by the Trump administration to undermine the 2010 health care law.

Here are points in the process the administration has affected the marketplace’s operation so far:

1. Insurers and states prepare for the beginning of open enrollment Insurers have to get their plans approved by the exchanges, and sometimes by state regulators. At the same time, states have to prepare for the open enrollment period which starts Nov. 1.
ROADBLOCK
Trump hasn’t said whether he will continue to fund key subsidies

It’s difficult for insurers to know how to price their plans because the Trump administration has not committed to paying cost-sharing reductions, subsidies that help offset low-income Americans’ deductibles and co-pays. Insurers in most states have raised their 2018 premiums significantly to account for the fact that it’s unclear whether the government will pay the billions in cost-sharing payments next year.

ROADBLOCK
Trump might not strictly enforce ACA's mandate to buy insurance

Whether federal officials strictly enforce the individual mandate, which requires taxpayers to provide proof of health care coverage, also affects insurers’ pricing. The more it’s enforced, the more likely it is healthy people will enroll, which in turn lowers insurers’ costs and what they charge for premiums.

ROADBLOCK
HHS is not helping states plan for enrollment season

Every year, the Department of Health and Human Services has sent regional directors to help states get up and running for open enrollment. This year, they’re not coming.

[The Health 202: Trump administration won't answer questions about Obamacare enrollment]

2. People learn about open enrollment People need to learn that the marketplace exists, whether they’ll be eligible for Medicaid or subsidies, and how to enroll.
ROADBLOCK
Trump has slashed the ACA advertising budget

The administration announced it would spend $10 million on advertising open enrollment, one-tenth what the Obama administration spent last year. That could mean fewer people will hear about the enrollment period.



ACA navigators tell people in their community about the open enrollment period and help them sign up for the exchanges. The Health and Human Services Department is slashing the navigator budget by 40 percent overall, up to 92 percent in some places. Some navigator organizations have already shut down as a result. Read more about this cut here.



3. People decide whether they want to enroll The decision is based on whether people think the marketplaces are functional and offering them good plans, as well as whether they think they’ll be punished under the individual mandate.
ROADBLOCK
HHS has put out negative advertising about the marketplaces

The Trump administration has advertised against the ACA. By emphasizing messages that the market is imploding or the plans are too costly, the administration has discouraged people from enrolling.

ROADBLOCK
Trump is expanding eligibility for joining “association health plans”

These plans would allow people to buy cheaper, less comprehensive insurance than is offered in the ACA marketplaces. Experts expect it to pull healthy people out of the marketplaces, increasing average costs and therefore premiums.

[IRS won’t withhold tax refunds if Americans ignore ACA insurance requirement]

4. People go through the enrollment process The process can be confusing and involved, so it can take people a while to get from first learning about the marketplace to completing their sign-up.
ROADBLOCK
The administration cut the open enrollment period in half

The open enrollment period, when people are able to sign up for the exchanges, used to span from Nov. 1 to Jan. 31. The Trump administration cut this in half, ending the period on Dec. 15. A spokesperson for HHS said this is because Obamacare missed its enrollment targets in the past. And beyond that, Healthcare.gov is being shut down for several hours most Sundays. Since people have less time to enroll, it’s likely that fewer people will get the message in time.



ROADBLOCK
The shorter enrollment will put more strain on Healthcare.gov

As it stands, Healthcare.gov has a hard time handling the surge of traffic in mid-December (so people can get insurance starting in the new year) and the end of January (so people can make the deadline). By changing the open enrollment period, these two surges will occur simultaneously in mid-December, according to Karen Pollitz of the Kaiser Family Foundation. Since there’s no signs the technology will be upgraded, this could cause the website to crash.


Kevin Uhrmacher contributed to this report.

https://www.washingtonpost.com/grap...no-name:homepage/story&utm_term=.14ed804ba773

 

[cigaretteman]

Since his election, President Trump's efforts regarding Obamacare have been almost all geared at undermining it. Now that Congress has failed to repeal the law, he's acting as much as he can on his own. And depending on how it's implemented, the executive order Trump signed Thursday could be his most significant step yet to sabotage the law.

It will expand the availability of plans that are loosely regulated and don't have to provide essential health benefits, which could pull people off the Obamacare exchanges. Here's a look at the options available to Trump to fix, save, undermine or gut Obamacare, and where this new executive order fits on that scale.

Option 1: Prop up Obamacare. Trump could support a bipartisan effort in Congress to provide regular subsidies to insurers to cover the cost of lower-income people who pay less under Obamacare.


Has he done this? No. Trump seems entirely uninterested in this. In fact, one of the reasons Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are trying to make these subsidies more regular is because they are concerned that Trump could suddenly stop issuing them. That could be calamitous for thousands of people who rely on them. Experts also warn that the unpredictability is bad for all health insurance markets because insurers don't know how much the government will be helping them out.

Trump has suggested that he might work with Democrats to pass some kind of ambiguous health-care overhaul. But no one in Washington is taking that seriously, especially given his 180 on an immigration deal with Democrats.

Option 2: Undermine Obamacare. If Obamacare is going to be the law of the land, Trump can try to cut holes in it so big that the law is unrecognizable. The approach seems to be to force Obamacare to fail, forcing Congress to fully repeal it.


Has he done this? Oh yes.

• Trump has slashed by 90 percent the federal government's budget to advertise and help enroll people on the exchanges.
• The Post's Juliet Eilperin reports that he's told the federal government to refuse to help Iowa prop up its struggling marketplace, which is a federal-state partnership.
• Add this executive order to the list: The Post's Amy Goldstein reports that the order will allow small businesses to form an association to negotiate health benefits, called association health plans. Under Trump's rule, these disputed plans could soon be sold across state lines with no regulation on what health benefits they have to cover.

Many state insurance commissioners, both Republican and Democrat, oppose expanding associations because doing so could allow a plan formed in Ohio that, say, doesn't include protections for preexisting conditions to be sold in Indiana, and there's nothing that Indiana officials could do about it.

Goldstein reports that the National Association of Insurance Commissioners warned Congress in February that something like this “would result in less protections for the most vulnerable populations and the collapse of individual markets.”

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In fact, aside from a few ideologically rigid conservatives, association health plans aren't really a mainstream discussion, said Paul Ginsburg, a health policy expert and director of the USC Brookings-Schaeffer Initiative.

“To aggressively pursue association health plans is very much an attempt to undermine the markets in the Affordable Care Act,” Ginsburg said.


Trump will also direct the government to expand the availability of short-term health-insurance plans, from three months to a year. That “could do serious damages to the marketplaces and the individual market,” said Gary Claxton, an analyst with the Kaiser Family Foundation.

These plans are designed to be short-term — say, if you're between jobs and can't get on the exchanges. They don't have to cover essential health benefits, they are not renewable, and they are cheaper. But Trump's order would make them closer to an alternative for full health insurance, which could make them an attractive plan for healthy people, which could increase the volume of sicker people on the exchanges.

“If you leave the sicker people on the exchanges, then premiums will rise more, and it gets you back to the possibility of a death spiral,” said Alice Rivlin, a health policy expert with the Brookings Institution.



Option 3: Fully gut Obamacare. Trump can't do this, because it's a law Congress passed. But he could put nonstop pressure on Congress to repeal the entire law.

Has he done this? Yes and no. Trump has made clear how frustrated he is that Republicans were unable to repeal Obamacare. But he has largely pivoted to overhauling the tax code.

There's one more thing health policy experts say Trump could do on his own to rip up Obamacare: end the payments to insurers that cover lower-income people's premiums (the very same payments Congress is trying to shore up). Most health-policy experts agree that if these subsidies are taken away without a change in how much lower-income people pay for their health insurance, insurance markets would implode, forcing insurance companies to leave Obamacare exchanges, causing Obamacare itself to implode.

As of Thursday, Trump has done everything to sabotage Obamacare but that.

https://www.washingtonpost.com/news...r-615am:homepage/story&utm_term=.2e5e6bcc41b5

 

[cigaretteman]

Two weeks ago, Republicans failed for the final time to repeal and/or replace Obamacare with their own health-care bill. And now that any changes will require 60 votes rather than 50, efforts are progressing to overhaul the law on a bipartisan basis.

But poison may be seeping into the well, thanks to the Trump administration's increasingly indisputable efforts to undermine the law.

On Thursday morning, President Trump is set to sign an executive order that will scale back Obamacare's regulations and make it easier to buy plans that don't meet the Affordable Care Act's requirements. Included in the new package is a rewriting of the rules for “association plans,” in which small-businesses join together to negotiate benefits. Also included are a lengthening of short-term policies with less coverage from three months to nearly a year, and an expansion of the use of pretax dollars for any medical expenses — not just policies that meet the ACA's requirements.


Critics worry that such moves will reduce enrollment in the Obamacare marketplace plans and drive up costs, further imperiling the law. And these are hardly the first examples. The administration previously flirted with cutting off subsidies for insurers who assist low-income customers. And, as The Post's Juliet Eilperin notes, the Department of Health and Human Services has cut the next enrollment period in half, made the HealthCare.gov website less available, reduced the advertising budget by 90 percent and cut funding for the groups that sign people up for coverage.

Last week came two more examples of this trend:

1. The Washington Post reported that the Republican-controlled Iowa state government approached the Department of Health and Human Services for help stabilizing its embattled health-insurance marketplace, but President Trump personally told the department not to help.
2. The administration issued a new rule Friday making more insurers and employers exempt from having to provide free birth control, potentially taking that benefit from hundreds of thousands of beneficiaries.

In case there was any doubt about what the administration is doing, this comment a couple weeks back from a Department of Health and Human Services spokesperson should put it to rest:




Obamacare has never lived up to enrollment expectations despite the previous administration's best efforts. The American people know a bad deal when they see one and many won't be convinced to sign up for 'Washington-knows-best' health coverage that they can't afford. For the upcoming enrollment period, Americans are being hit with another round of double-digit premium hikes and nearly half of our nation's counties are facing Obamacare monopolies. As Obamacare continues to collapse, HHS is carefully evaluating how we can best serve the American people who continue to be harmed by Obamacare's failures.

Judging by that statement and the moves described above, it's clear the Trump administration isn't going to lift a finger to salvage the law and make it workable for the foreseeable future. It seems anxious, in fact, to usher in its demise.

If you truly believe Obamacare is failing and that the whole thing is throwing good money after bad, that may seem like a justifiable thing to do. As a political strategy, it could also apply pressure on lawmakers to come up with a bipartisan fix sooner than later. And it could serve to reinforce the law's problems in the minds of voters.

But if you're a Democrat preparing to work with congressional Republicans and the administration on fixes to Obamacare, it has to give you pause. The law's proponents are increasingly exasperated by what they feel is the administration failing to act in good faith and not attempting to make the current situation work. Some have labeled it “sabotage.”

There seems to be some progress on the deal being negotiated by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). But at this point, you have to wonder how much faith Democrats have in the administration to faithfully implement whatever is negotiated. And at the very least, this is injecting some passionate disagreements into a debate that requires the two sides to come together.

https://www.washingtonpost.com/news...r-615am:homepage/story&utm_term=.a6430c252840

 

[ottumwan in tx]

everyone is clapping and cheering