Republicans are crying crocodile tears over Obamacare problems again. Their concern might be more convincing if they’d stop acting as though there’s nothing they can do about it, or at least stop making things worse.
The latest unmitigated bad news the GOP is using as fodder for its Affordable Care Act repeal campaign is that Anthem, one of the biggest health insurance companies in America and the major player on the exchange marketplaces, is all but pulling out of Ohio. Unless another insurer steps in, that will leave 10,500 consumers in 18 counties potentially with no source of health coverage next year.
Parts of Iowa, Missouri and Nebraska are on a path to being in the same predicament. The Anthem development is especially worrisome, since the company currently covers more than 1 million people in 14 states’ health insurance exchanges.
Yes, people like House Speaker Paul Ryan (R-Wis.) have characterized the Republican campaign to repeal and “replace” the Affordable Care Act as a “rescue mission” to alleviate the great burden of Obamacare on the American people. But the American Health Care Act ― which the House passed last month and which the Senate GOP is using as the foundation for a new bill ― mostly would just “rescue” 23 million people from having any health insurance at all.
The House-passed legislation is more about un-helping the people Obamacare covered than about helping those who still can’t bear the expense of health insurance and health care. Making insurance unaffordable or unavailable to poor families and people with pre-existing conditions is an unusual way to improve the health care system.
But the gaps in places like Ohio, along with continued problems with affordability ― especially for those who aren’t rich, but earn too much to qualify for the Affordable Care Act’s tax credit subsidies or Medicaid coverage ― plainly illustrate that many of these state marketplaces are in need of care and feeding if they are to flourish. And while more insurers’ balance sheets are showing signs that the Obamacare markets are stabilizing, other companies continue to lose a lot of money.
Instead of undertaking the routine act of managing government programs for the good of the people who use them and the taxpayers who finance them, the Republican Congress has spent the past seven years not only rhetorically tearing down Obamacare, but literally doing so. They’ve had the eager cooperation of Republican officials at the state level and, now, of the Trump administration.
Congress cut money for health insurance companies, exacerbating their financial situations as they adapted to a new market in which they had to actually cover sick people. Congress ignored President Barack Obama’s proposals to make the markets better and the coverage more affordable. State officials deliberately hampered federal enrollment efforts. Republican officials in 19 states rejected the Affordable Care Act’s Medicaid expansion, which drove up costs for people with private coverage by adding more sick people to the insurance pool.
To be clear, Congress could’ve chosen a different path after Obama signed the Affordable Care Act in 2010, and still could do so now.
Trump has been threatening since before even being sworn in that he would withhold money owed health insurance companies that cover poor households because, in his mind, this will scare Democrats into participating in the repeal of the Affordable Care Act. Congress could eliminate this threat by guaranteeing in new legislation that insurers will get their money.
Another positive step would be restoring a funding stream, which Congress stripped in 2015, to backstop health insurance companies that suffered higher-than-expected costs.
Perhaps ironically, the American Health Care Act actually includes money intended to help states steady their insurance markets, just not enough to actually achieve that aim. And it comes with hundreds of billions in cuts to health care programs, and those millions of people who’d become uninsured and have to bear the full cost of all their medical care, or simply go without and get sicker.
Alaska and Minnesota already have enacted programs to help insurers with the sickest, costliest patients by establishing funds to reimburse them for extraordinary expenses from those patients, which is supposed to bring down premiums for the rest of their customers.
The Trump administration actually encouraged this, and published a separate regulation tightening the rules around health insurance enrollment at the behest of the insurance industry. Those steps undercut the White House refrain that Obamacare is unfixable and support the notion that tweaking the law can make it work better, albeit not perfectly.
One of Trump’s first acts as president was to issue an executive order instructing federal agencies to relax Affordable Care Act regulations, leading insurers to fret that means the IRS won’t enforce the law’s individual mandate, which they see is important to nudging low-cost healthy consumers into the market. Another of Trump’s first acts was to cancel advertising for the end of this year’s enrollment period, which suppressed signups at a crucial time.
What’s more, Trump’s coy game-playing over the money owed insurers is a primary cause of the bad news from Ohio and elsewhere.
Insurers in states including North Carolina and Pennsylvania are seeking massive rate increases for next year ― above what they otherwise would’ve been ― citing uncertainty about whether Trump will pay the money. Insurers in other states will follow unless the president stops threatening to stiff them, or if Congress simply appropriated the funding to which they’re entitled under the Affordable Care Act.
This uncertainty is the biggest danger to the functioning of the health insurance system right now. Trump hasn’t even committed to making these payments for this month, let alone in the future.
Any efforts lawmakers did undertake this year to shore up the health insurance market for millions of American consumers isn’t necessarily even incompatible with eventually repealing the law. There will be a time between 2018 and whenever a GOP health care bill took effect when people will still need to use the current system ― if there is one for them to use where they live.
Trump and Congress are running out of time. Health insurance companies face looming deadlines in the coming weeks to declare their intentions for next year. And if more of them bail on the exchanges or raise rates by an average of 19 percentage points above what they otherwise would’ve raised them because the party in power mismanaged the program, polls show the public will blame the GOP.