| Today's Managing Health Care Costs Number is 90% |
We want those with serious illness to have health insurance as a matter of public policy and basic human decency. We don’t want US residents dying on the hospital steps, and we don't want people to have bake sales to pay for their chemotherapy. We also don't want hospitals going bankrupt caring for those without insurance, and we don't want individuals losing their homes to liens placed by hospitals for emergency care delivered.
We also want healthy people, those least likely to "need" insurance, to have health insurance. If only the sick have insurance, premiums would go through the roof. If most healthy people opted out of health insurance, the insurance market would shrivel and die, as those with the least needs dropped out each successive cycle. That's the essence of the dreaded "death spiral."
The Trump administration announced this week that it would cut advertising for the Affordable Care Act exchange plans by 90% for this open enrollment period. Having failed to repeal the law, they are seeking to fulfill their predictions of the ACA imploding by starving the exchanges of their lifeblood- the relatively healthy.
There's been good reporting in the New York Times and Vox about the other efforts the Trump Administration has made to decrease the likelihood that healthy people would sign up for insurance through exchanges this next cycle.
- The New York Times reports that CMS removed "helpful links on its website on the day of Trumps inauguration, including summaries of benefits, emergency services, and doctor choice, making it more difficult for consumers to learn about the law."
- CMS announced a 40% cut in navigators to do Obamacare outreach. Sarah Kliff of Vox reports today that the navigator cut is worse still. The navigator nonprofits have received no funds at all -and have been told that no grants will be retroactive so that staff must be laid off now. Perhaps they will still be available to be rehired for the November 1 open enrollment. Perhaps not.
- HHS is spending some of the marketing dollars not attracting healthy people into the ACA markets, but rather attacking the law. The New York Times notes that CMS produced dozens of YouTube videos and infographics with strident anti-ACA messages.
- The IRS announced it would accept tax returns with no notations in the query about health care coverage, telegraphing a lack of interest in collecting the individual mandate penalty, which is largely aimed at being sure to encourage healthy low-cost people to join or remain in the plan
- The monthly threat to withhold Cost Sharing Reduction payments has led many health plans to price their premiums assuming the CSRs will go away - making health insurance less affordable - especially for those who get little or no government subsidy
It's no secret that the Trump Administration is filled with those who want to eliminate the Affordable Care Act. They failed legislatively - and they have shifted their effort to strangulation of the ACA exchanges. Efforts to deprive the exchange plans of the healthy members they need for financial viability could still make ACA plans unavailable for millions, and unaffordable due to adverse selection for millions more. In some instances, their efforts could persuade more insurers to exit the market - which will lead to more "bare counties," lost subsidies, and millions more uninsured.
These executive actions aren't subject to Congressional Budget Office study- so we won't see headlines about their impact. But they will certainly lead to a higher percentage of Americans uninsured in 2018.
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