Here’s a thought exercise. Barack Obama never once considered repealing George W. Bush’s Medicare Part D law, even though it was a drag on the budget. But imagine if he had decided to try. Imagine, then, that this hypothetical repeal effort failed three times in a row, despite congressional majorities, and so instead Obama decided to issue executive orders aimed at making it really difficult for seniors to receive the prescription drug benefits in the law? I mean, radically undermining the law might have reduced the deficit and the long-term debt, especially if retirees were simply unaware of the program and didn’t enroll, right? But it would have been a horrifyingly crappy and inhumane thing to do, given that seniors would have been forced to go without life-saving medication or go bankrupt trying to pay for prescriptions.
In truth, Medicare Part D came equipped with a pretty significant problem. It turned out that many seniors were being screwed every year by something called the “doughnut hole.” Simply put, a flaw in Bush’s Medicare Part D manifested itself with a coverage gap, during which recipients had to pay for medicine out of pocket or go without their prescriptions for a period of time each year. Rather than maniacally demanding a repeal of the law, though, the Obama administration and Democrats in Congress incorporated language in the health care law of 2009 that incrementally fixed the doughnut hole.
Why? Because that’s the grownup thing to do -- the human thing to do. (Incidentally, repealing Obamacare would’ve meant a re-opening of the doughnut hole. Bad news for all those seniors who inexplicably voted for Trump last year.) Nevertheless, the Affordable Care Act’s fix for Part D is how it’s supposed to work. If one president passes a beneficial law that improves people’s lives, the next president should endeavor to correct any glitches. That's how it went in that case, with a bipartisan effort linking two profoundly different administrations.
But it doesn’t work like that any more, apparently. Now, in the erratic and vulgar age of President Trump, the mission has never been to improve the ACA, which among many positive line items provided 20 million Americans withe affordable health insurance. The solution has been to simply kill it. The most brainless and simplistic solution for a brainless and simplistic regime. It reminds me of one of those viral videos in which a petulant kid starts relentlessly destroying his keyboard because of a computer glitch. Good job, kid.
Likewise, the Republicans got caught up in their own bogus hype from 2010, becoming unable to pull out of a nosedive commitment that they would repeal and replace the ACA. Because it tests well with the conservative base to promise a sucker punch to our first African-American ex-president, they couldn’t change course when it became clear most Americans beyond the loony fringe didn’t want anything to do with the slapdash Republican replacement bills. Hence, three failed attempts (at least) to repeal.
In the face of those failures, the Trump administration has engaged in a secret plan to sabotage the ACA. The goal? Make it really difficult for people to enroll and receive benefits from the law, while also jacking up premiums by resurrecting failed solutions. What exactly are they doing?
On Wednesday, we learned that Tom Price’s Department of Health and Human Services, which is tasked with implementing the ACA, sent word to all 10 of its regional directors to bail out of promoting this year’s open enrollment period. The goal, quite obviously, is to keep people from enrolling in order to facilitate a decline in participation, creating another excuse for another possible repeal, and perhaps triggering premium hikes to compensate for the lack of customers paying into the system.
Referring to the lack of promotion, the executive director of the Mississippi Health Advocacy Program, Roy Mitchell, told Vox’s Dylan Scott, “It’s clearly sabotage.” Senate minority leader Chuck Schumer agreed: “The Trump administration is deliberately attempting to sabotage our health care system.”
If customers forget to enroll as a result of the sabotage, they’ll be forced to pay a penalty. Many of those lapsed customers will surely become opponents of the law. Mission accomplished. Trump already signed an executive order shortly after his inauguration ordering the IRS not enforce Obamacare's individual mandate -- another trick that is likely to trigger premiums. So far, at least, the administration has failed to implement the order.
Late last month, we also learned that Trump is slashing the ACA’s advertising budget by 90 percent, from $100 million to $10 million. TV ads are being scrapped altogether. The White House’s logic on this is predictably confounding. Officials told reporters that they shouldn’t be obligated to promote something which many Americans don’t know about. Isn’t that the point of advertising -- to inform the uninformed?
Likewise, the network of health care “navigators” tasked with helping Americans buy marketplace insurance plans is seeing its funding cut nearly in half, from $63 million to $36 million. Again, a valuable resource for making it easier to deal with complicated insurance parameters is being subverted. But I’m sure there won’t be any customers flummoxed by the process who will walk away hating the ACA.
Oh, and the open enrollment period has been reduced by six weeks, rolling back the deadline from Jan. 31 to Dec. 15, making the signup process even more harrowing.
The Trump administration has also threatened to stop paying cost-sharing reduction (CSR) payments. Briefly put, CSRs are the subsidies that help low-income families pay their monthly insurance premiums. The mere threat of cutting these payments has precipitated a forthcoming 45 percent hike in premiums in Florida alone. Insurers are specifically citing the “political uncertainty” brought on by Trump’s incendiary language, and the looming concern about the possible elimination of CSR payments.
Finally, for some reason that defies explanation, HHS will be shutting down the Healthcare.gov website for 12 hours every Sunday, a day when most Americans are off work and might well have the free time to focus on signing up for insurance. Rather than conducting technical maintenance when it’s needed, HHS is establishing weekly shutdowns with the apparent goal of making sure that fewer people can sign up during the shortened enrollment period -- and that’s if they’re actually aware of open enrollment, given the reduction of the advertising budget.
Ultimately, of course, we’ll continue to hear rhetoric from Trump about how the ACA is collapsing, forcing us to wonder whether his sneaky meddling with the law is causing the system to slowly unwind. The next time Trump screeches to his cosplaying superfans about rising premiums, it might be fair to point out that higher premiums next year and the year after that were essentially designed to happen and are his fault, not the fault of the underlying law. Not only will Democratic lawmakers be tasked with coming up with solutions for the existing glitches in the ACA, they’ll also have to contend with a White House that’s creating a long list of new ones -- deliberately and without remorse, effectively making health care terrible again and screwing over vulnerable Americans by the millions.