Faced with repeated failures by the GOP-led Congress to overturn the Affordable Care Act, President Donald Trump has taken steps to nudge what’s known as “Obamacare” into premature collapse.
This is not the way to reorder one-sixth of the nation’s economy that health care represents. Congress has the power to intercede and must act to stabilize, rather than undermine, a statute that is still the law of the land and has increased health security for millions of Americans.
As presented, the current government plans to blow up Obamacare, apparently unconvinced that this will threaten the lives and well-being of citizens, especially those in a lower income bracket.
That goes for Hawaii, as well, despite the fact that the state’s own longstanding law, the Prepaid Health Care Act, has kept the rate of the islands’ uninsured relatively low. With the passage of the ACA, the number of lower-income people who got help with purchasing health insurance increased here as it has across the country.
This was the real reason for an increase in Medicaid spending cited by U.S. Sen. Ron Johnson, R-Wis., who called for an explanation from Hawaii and other states. Last week, Gov. David Ige provided the answer: Hawaii took the opportunity the ACA provided to expand its health-care reach to its poorer residents.
At week’s end, the president delivered a one-two punch to the signature law of his predecessor. The first was an executive order to loosen the regulations enabling the creation of insurance plans that could be sold across state lines with more restrictive benefits.
These were aimed at increasing choice and would make things cheaper for younger, healthier purchasers. But in siphoning them away from the general insurance pool, experts agree, premiums would be driven up for those with greater medical needs.
Then late on Thursday, Trump also moved to cancel federal subsidy payments to insurance companies that were designed to contain consumer costs. The argument was that these subsidies were illegal — the subject of litigation against the ACA.
The administration of then-President Barack Obama issued what are called Cost Sharing Reduction subsidies to health insurers, even though the funds were never appropriated by Congress, which by the time the law rolled out fully was controlled by the Republican Party.
And the GOP has pledged its intention to dismantle the law ever since it was enacted. That vow eventually was framed as a “repeal and replace” initiative, substituting something Trump promised would be better.
Nothing of the sort ever materialized. There were various proposals, each of them cobbled together to gain the minimum required support to be enacted under the U.S. Senate’s “budget reconciliation” rules. Those constraints meant that the overhaul of the law drained away funding for the ACA’s key expansion of the Medicaid health coverage for the poor, but could not restructure the insurance markets to the satisfaction of the most conservative members.
As a result, none of the proposals to date was able to garner even the needed simple majority. Lawmakers and the executive branch should focus on a bipartisan effort to stabilize insurance markets so that further, lasting reforms can be negotiated. Instead, there is this precipitous move that’s ultimately going to hurt the people health care reform was intended to help.
The legal battle over the subsidies is not yet resolved. The case, now dubbed House of Representatives v. Price, is still on appeal,
although the Trump administration, not surprisingly, already had backed away from defending the Obama-era subsidies.
The GOP critics contend that the unappropriated subsidy funding is illicit, while the law’s current defenders — comprising a coalition of states’ attorneys-general — maintain that a part of the ACA mandates that the federal government offset the out-of-pocket costs for consumers who earn below a set threshold.
These include a lot of working families who suddenly will find that, without an assist, they will no longer be able to afford premiums on their salaries. And those premiums are likely to rise further if those with any significant need for a doctor’s care are sequestered within a high-risk insurance pool.
Now several of states are lining up to sue the administration over its action, making the persuasive case that the sudden halt in payments will rock the markets, causing more carriers to drop out. This could start happening immediately, with the next federal payments coming due Oct. 20 and the start of enrollment set for Nov. 1.
Rather than stand back and watch the system crater before their eyes, members of Congress need to do their job and authorize payments, making the prolonged court battles moot. Then leaders should resume their work toward a bipartisan, long-term solution.
The greatest tragedy is that such crucial policymaking has deteriorated to this state. It’s anything but healthy for the nation.
