The following article by Steven Pressman was posted on the Conversation website July 18, 2017:
The congressional effort to overhaul the health care system appears to be in shambles. But the current health care system lives on. And decisions the Trump administration makes about how to manage it could have big effects on who has coverage next year, and what it costs them.
The Department of Health and Human Services is in charge of administering Obamacare, and so far the department’s staff has given many public indications that it does not enjoy such duties.
The Department of Health and Human Services is in charge of administering Obamacare, and so far the department’s staff has given many public indications that it does not enjoy such duties.
The press office for the department can be counted on to send a news release each time there is bad news about insurers leaving markets around the country, often describing the health law’s structure as “collapsing.” It has been publishing vaguely sourced maps each week, highlighting in red the regions of the country where it says no insurers are willing to sell health plans next year.
“The situation has never been more dire,” the department’s secretary, Tom Price, said in a July 10 statement.
“Insurers continue to flee the exchanges, causing Americans to lose their choice of health insurance or lose their coverage altogether,” said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, which oversees the Obamacare health insurance markets.
It is true that the markets are looking shaky in some places. There are regions of Nevada, Indiana and Ohio where no insurers wish to offer Obamacare plans next year. In many other locations, competition has declined. And it appears that insurers are requesting hefty rate increases in many of the places they will stay.
But the Trump administration, rather than working to solve those problems, has mostly described them as failures of the previous administration. The White House has declined to say whether it will continue to pay certain subsidies to plans for very low-income Americans, subsidies seen as vital to the financial health of the exchange business. And it has suggested that it might decline to enforce the law’s individual mandate. Both of those actions will tend to raise prices, discourage insurer participation and make Obamacare shakier than it would be otherwise.
While premiums for Obamacare plans rose sharply for many customers this year, a growing body of evidence suggests that the insurers still in the market have begun making money and would be likely to stay if not for the administrative uncertainty. So far, there has not been a widespread run for the exits among insurers, but that could change if the companies feel that the administration wishes to actively undermine the markets.
President Trump, for the moment, appears to be leaning toward that course of action. In a Tuesday morning tweet, he wrote, “Let Obamacare fail and then come together and do a great healthcare plan.” Later in the day, he told reporters that Republicans should “let Obamacare fail,” adding, “I’m not going to own it.”
Republicans control both houses of Congress and the White House. But they have demonstrated that there is not enough agreement within the party to pass a major health overhaul bill. Mr. Trump’s argument is that catastrophe in the insurance markets will be enough to bring Democrats to the negotiating table. That could be a risky strategy.
There is, of course, another possible path. The Trump administration could take actions to reassure insurers and help stabilize markets. It could promise to fund the special subsidies, at least until the end of this year. It could signal that it will instruct the I.R.S. to continue enforcing tax penalties for Americans who lack health insurance. It could promise to advertise Obamacare’s fall sign-up period, increasing the number of Americans who learn about the program and get coverage. It could reach out to carriers and insurance commissioners to help them find ways to remain in bare markets.
It has the power to minimize damage from any of the current health law’s flaws. At the moment, that does not appear to be the chosen path.
View the post here.