You know the old saying.
If you can’t repeal ‘em, then sabotage ‘em.
That’s exactly what some people say the Trump administration is doing with the Affordable Care Act (ACA).
In fact, President Donald Trump said last month that his plan was to “let Obamacare fail” and then force Democrats to work with Republicans on proposals to repeal and replace the nation’s healthcare law.
Those were not idle words.
The White House can do plenty to help shove Obamacare over the cliff in the next few months.
Those actions range from failing to provide financial assistance to ignoring some of the ACA’s laws to scrapping advertising and publicity for the upcoming enrollment period.
Indeed, the Trump administration has already instituted some of these anti-ACA policies.
And this is all happening as health insurance companies nervously await some important upcoming deadlines.
“There’s a difference between letting Obamacare fail and making it fail,” said Kurt Mosley, vice president of strategic alliances at Merritt Hawkins healthcare consultants.
What’s already happening
At this point, most people in the United States apparently want Obamacare fixed — not repealed.
A poll released Friday by the nonpartisan Kaiser Family Foundation stated that 60 percent of those surveyed said it was “a good thing” that the Senate failed late last month to approve a bill that would have repealed Obamacare.
Another 57 percent said they want Republicans and Democrats to work together to improve the ACA.
And 78 percent said they want the Trump administration to make the current healthcare law work. Only 17 percent said the White House should do what it can to make the ACA fail.
Despite the one-sided sentiment, the Trump administration has already begun efforts to undermine the ACA.
One of the chief strategies was revealed when President Trump threatened late last month to end the federal subsidies to insurance companies. These subsidies help pay for lower income customers’ premiums.
The federal government distributes about $600 million a month in these subsidies to insurance firms.
A decision on these payments needs to be made soon.
On August 21, the next round of monthly cost-sharing subsidies is scheduled to be sent out.
On September 5, insurers in 39 states that use the federal marketplace must submit any final adjustments they want to make in their proposed 2018 premium rate requests. The original deadline was going to be later this week, but last Friday the White House extended that deadline until the first week of September.
On September 27, insurance firms sign contracts to participate in the 2018 ACA marketplace.
Experts say if the president follows through on his threat to withhold subsidies, that could prompt insurers to seek even higher rates or drop out of the market altogether.
“It could create chaos,” Mosley told Healthline.
In fact, the president’s words have already produced uncertainty.
A report by the Kaiser Family Foundation released last week stated that the looming threat has triggered double-digit increases in the preliminary premium requests from insurance companies.
In 15 major U.S. cities, the report concluded, there are premium increases of more than 10 percent slated for consumers who buy insurance in the ACA marketplaces.
The report also stated that fewer insurers are expected to offer ACA plans than at any time since Obamacare began in 2014. On average, there will be 4.6 insurers per state, down from 5.7 insurers this year.
Experts say that even if the Trump administration decides on a month-by-month basis whether to pay the subsidies, it could be unsettling to the insurance market.
If the subsidies are ended, that will affect more than consumers.
Experts say hospitals would face an increase in uncompensated care from patients who don’t have insurance.
Enrollment is another arena where the Trump administration could hurt Obamacare.
Fewer people participating in the ACA markets would further weaken the system.
The White House has already taken steps in this direction.
Last month, administration officials ended contracts in 18 major cities for people known as facilitators.
These assistants worked in libraries, businesses, and urban neighborhoods, helping people sign up for ACA insurance coverage.
Without them, experts say enrollment will decline.
“They are absolutely essential,” Dr. Meghana Rao, an OB-GYN who is on the board of directors for Doctors for America, told Healthline.
“It’s critically important that consumers have some place to go,” added Jeananne Sciabarra, executive director of Consumer Health First.
In addition, in April, officials at the Department of Health and Human Services (HHS) shortened the enrollment period in states under the federal marketplace.
Enrollment was originally scheduled to last from November 1 to January 31. That has been reduced to November 1 through December 15.
State-run exchanges have been encouraged to follow the same schedule.
Healthline contacted HHS officials for comment. A representative asked that Healthline email questions on these and other issues.
The email questions were sent, but HHS officials didn’t respond with answers.
What could happen soon
In the next few months, there are other ways the Trump administration could help derail Obamacare.
For starters, the White House could reduce or eliminate advertising and publicity for the upcoming enrollment period.
The administration already did this in late January at the end of the 2017 enrollment period when it pulled $5 million of Obamacare advertising.
The administration could also decide not to enforce the individual mandate.
That’s the requirement that everyone have insurance coverage. Those who don’t face a tax penalty when their file their income tax returns.
In fact, the Internal Revenue Service (IRS), under the direction of Trump administration officials, announced earlier this year it would process tax returns where the filer declined to state whether they had insurance.
The IRS could also decide not to enforce the tax penalty for those who do admit they went without insurance the previous year.
Experts say the individual mandate is crucial because it provides insurance companies with lower-cost, healthy individuals to balance out their more expensive, less healthy clients.
The administration could also decide not to enforce the ACA mandates on the minimum insurance requirement that employers must provide to their employees.
That could result in less healthcare coverage for people who get their insurance through their workplace.
The administration could also hurt Obamacare by what Sciabarra calls “sabotage through neglect.”
That includes not keeping the ACA website up to date or slowly processing government paperwork.
Whether the Trump administration will proceed with any of these measures is anybody’s guess.
“I think they figure if they let Obamacare fail, then they can blame the Democrats,” said Mosley. “But I don’t think that will work.”
“I wish I could predict what this administration will do,” added Rao. “I really hope they don’t go through with this.”