by Countable | 7.20.17
On Tuesday, the seven-year quest by Republicans to repeal and replace the Affordable Care Act, popularly known as Obamacare, appeared to come to an end, and President Trump responded to the setback by vowing to "let Obamacare fail."
"It’ll be a lot easier," Trump said at the White House.
“We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.”
With Obamacare entrenched in many states, and numerous governors (and, apparently, senators) supportive of the legislation, what can the Trump Administration actually do to try and tank Obamacare?
END INDIVIDUAL MANDATE
On Wednesday, the nonpartisan Congressional Budget Office (CBO) estimated what would happen if Obamacare were to be repealed without a replacement. The CBO predicts 32 million people would lose insurance by 2026, including 17 million by next year. The CBO also estimated that, compared to current law, premiums would nearly double by 2026. Medicaid expansion would end in 2020.
Much of this was based on the elimination of the individual mandate, which requires all Americans sign up for health care, regardless of age. By repealing the individual mandate, those who would most likely remain enrolled in health care would be those Americans with an immediate health care need: primarily older and sicker Americans. That demographic is the costliest to cover, so this in turn would cause insurers to have to dramatically raise their rates. The Trump administration needs Congress to repeal the individual mandate, but it can direct the Internal Revenue Service (IRS) to soften its enforcement of the mandate.
WITHHOLD PAYMENTS DUE
This is one of the most lethal strategies, and has been referred to as the "Nuclear Option" for killing Obamacare.
Insurance companies are owed billions of dollars in "cost-sharing reduction" payments. Under the ACA, insurance companies reduced the deductibles of low-income customers, with the understanding that the government would reimburse them. According to the Kaiser Family Foundation, in 2016 the federal government paid an estimated $7 billion in cost-sharing payments, on behalf of 6.4 million marketplace customers.
For months, President Trump has been threatening to withhold this money. In response, insurers have claimed they’re already raising 2018 premiums. Some insurers have also warned they may pull out of additional counties if they can’t be guaranteed reimbursement. (There are even a handful of counties that have no individual insurers lined up for 2018.)
Anthem, one of the nation’s leading healthcare providers, decided to exit various markets in June because of all these unknowns. In a statement, the company said their concerns include "continual changes in federal operations, rules and guidance" and "an increasing lack of overall predictability."
FAIL TO PROMOTE OPEN ENROLLMENT PERIOD
With few exceptions, individuals can only change their insurance, or sign up for new insurance, during the marketplace’s open enrollment period. President Obama made it a priority to spread the word about open enrollment and get people signing up. This included commercials, Tweets, and offbeat interviews, including the one on Between Two Ferns.
By refusing to promote the exchanges, or directing people to sign up, the Trump Administration could cause a steep decline in new enrollees. It’s a more roundabout way of attacking the individual mandate, but one that will cause insurers to take a hit nonetheless.
While Obamacare may or may not be the "disaster" Trump has claimed it to be on numerous occasions, it is in a precarious position: if the ACA is a game of Jenga, Trump certainly has ways to remove some key blocks to help it tumble.
Should the GOP preemptively work with the Democrats on the ACA? Or should Republicans, as Trump suggested, "let Obamacare fail, and then the Democrats are going to come to us"? Tell your reps and comment below.
(Photo credit: Gage Skidmore via Flickr / Creative Commons)
Written by Countable
Donal Trump wants to destroy anything associated with President Obama; his narcissistic desire to win and destroy anyone he feels may have "beaten" him. He has consistently lied about the status of the ACA and both the Senate and House bills will deprive millions of Americans of healthcare. Numerous medical and bipartisan studies plus the CBO have pointed out the flaws in these bills. Thousands will die without the help they receive from Medicaid. The Democrats will work with you to fix the flaws in the ACA and you can change the name is that will sooth Trumps ego. All of you claim to be Christians, so please act it and show some compassion.
We got to do better than this sad excuse for a President. This man is not a leader in any sense of the word. Replace Trump not the ACA....
The ACA needs to be tweaked! No need to destroy it or put Americans in dire straits. This needs to be a bipartisan effort. Not one of power to these GOP men! It's about American healthcare not a power trip. Additionally please engage women in this process.
Why repeal or destroy ACA? That in itself seems destructive and a waist of time/money. Work on making it better by having bipartisan participation (including women) on the committee. It can be better, but too many don't like who put forth this plan. All people should have affordable health insurance. In the long run, society will be better off.
They for some reason want to destroy Obama... not the ACA until they stop that thinking the country will not stand with the GOP.
The ONLY way is single payer at this point. Nothing else works or has worked. Repealing then replacing Obamacare will be the death of healthcare. Millions will lose, hundreds of thousands will die. When will congress see the light and give the people of this country one of our basic human rights...affordable healthcare? Medicare for ALL!!!
Obamacare was implemented by Congress therefore it can only be undone by Congress. Republicans: We live in a democracy, not under a dictatorship or an oligarchy.
IF Trump takes the "nuclear option" as it is called and instead of "letting" the ACA fail, CAUSES the failure Congressional Republicans who stand by idly WILL watch their political careers DIE from the FALLOUT... as millions of NEW highly motivated political activists are unleashed .. with only one purpose to Repeal and Replace the Republican Party.
The time for party loyalty is over there is a lunatic in the White House and you continue to put party over people.. two New Democrats voted in in Oklahoma should be wake up call that change is coming 2018 🎉
Healthcare assures life, liberty and the pursuit of happiness as it was originally written, for people with disabilities. Being anti-abortion/pro-birth isn't the same as being pro-life. Healthcare assures people have the resources needed to stay alive. Not to mention, it seems as though the President wants to do this out of spite.
If the ACA fails, it is on the Republicans and on Trump. Shows a total lack of concern for the American people.
Please do not allow Congress and the Trump Regime to hasten the demise of the ACA by withholding payments ending the individual mandate or simply just upending insurance markets. Please identify the problems with the ACA and fix it. A fix should not include massive tax cuts for the rich. Reducing prescription costs would also go a long way to help improving costs for all Americans
If Congress had to obtain health insurance coverage via Obamacare rules, it would be fixed without delay!
Obamacare is repealing itself, the market has spoken.
The house and the senate should work to improve the Affordable Care Act! Democrats and republicans should work together for the good of the American people! No more sneaky meetings! No more talk of repeal! No more coercive lunches! Republicans will be responsible if the Affordable Care Act fails because they withhold payments! Do what you were elected to do and what is best for the general public!
Repeal the ACA. Only free market competition will provide quality affordable healthcare.
Obamacare has epically failed the middle class and forced many of us out of insurance simply to pay for a few uninsured. Apparently, "the needs of the few outweigh the needs of the many."
Just a reminder that your hatred of Trump doesn't negate the disaster that is the ACA. And for those of you demanding single payer (eye roll), just remember, that means Trump would be in charge of your healthcare... think about that for a minute.
We desperately need Medicare for all, single payer! everyone's covered including Congress.
If Trump allows Obamacare to fail without voting on a replacement I guarantee he will lose the election in 2020.