Is Trump Sabotaging the ACA?

Since his election, Trump has worked to repeal the ACA. We discuss what he has accomplished.

The Affordable Care Act has been under attack by constant Republican efforts to repeal, defund, or delay its provisions even though it is a bipartisan bill.[1]

Trump promised great health care for everyone while he was a candidate. However, he has done whatever possible to weaken the ACA since being elected. He has been unable to introduce an acceptable bill to replace the current programs, as he pledged, so he has focused on repealing the ACA.

Defunding

Trump’s first step toward his goal was “budgetary reconciliation,” a bill that can be passed by a simple majority to change tax spending. The provisions changed may not be policy-related. This is the crux of Senate Parliamentarian Elizabeth MacDonough’s opinion that policy decisions such as cutting family planning services by defunding Planned Parenthood are policy matters needing to be ruled on my a 60% majority, not 51%.[2] Mike Pence has statutory authority to overrule the parliamentarian but has not yet done so. Removing funding from several programs under the initial budget reconciliation is now in doubt.

Discouraging Publicity

Another of Trump’s initial efforts was removing ads for Open Enrollment during the open enrollment in the period that ended on January 31, 2017. Although the ACA (ObamaCare) was still in full force, this may have contributed to declining enrollment. However, many people rushed to sign up for the ACA as fears increased that it would become unavailable in the future.

Ignoring Mandates

Trump tried to remove the teeth from the mandate to carry health insurance or pay a fee. Removing the mandate cuts funding for the program and encourages younger, healthier people to opt out. Under pressure, the IRS relaxed its stance and now accepts Tax returns without assurances the filer is insured. There does not appear to be any current enforcement of the mandate, which was a source of funding for the ACA. Please see The Ongoing Political Strategy to Break ObamaCare for more information.[3]

Stopping Medicaid Expansion

Trump tried to discourage states from expanding Medicaid by slowing or stopping federal funding for expansion. Although insurance companies were seeing their markets stabilize and were making good profits, the resultant uncertainty over the future has driven many of them out of the market, especially in Republican states that did not expand Medicaid.

Republicans are promoting the fictitious idea of an “ObamaCare Death Spiral.” See the Kaiser Foundation’s publication Individual Insurance Market Performance in Early 2017.[4] See also our page ObamaCare Death Spiral and the Idea Democrats Forced the ACA Through are Myths.[5]

Work Requirements

Some states want to begin requiring work from Medicaid recipients assuming that they are not contributing members of society. This is presented as a way to discourage “freeloaders” from the program. In fact, many Medicaid recipients work for minimum wage. We assume this will only apply to non-elderly adults without disabilities. This seems like more of an emotional appeal playing to people’s fears that their money is going to fund “lazy” people who should be working. See Are Able-Bodied Adults Taking Advantage of Medicaid?[6]

Subsidies

Trump has not yet agreed to continue to pay the subsidies that help low-income Americans to buy health insurance. If he stops paying the subsidies, insurance companies will see their profits reduced, and smaller companies might fail entirely. He has also proposed making tax benefits less generous for those with health insurance.Trump said he will “let ObamaCare fail” and taken steps toward ensuring its failure. See Trump’s Attempts to Sabotage Obamacare Are Working.[7]

Modifying Essential Benefits

The current administration has discussed modifying the 10 essential health benefits such as preventive services including contraception. This would put many people, even those with employer-based coverage, at risk.{cite]New Changes to Essential Benefits in GOP Health Bill could Jeopardize Protections Against Catastrophic Costs, Even for People with Job-Based Coverage[/cite]

Cost and the ACA

We can be pretty sure that the high cost of health care in our country is related to our for-profit health care system rather than to anything the ACA may have done. See Did the ACA Lead to High Medical Costs?[8]

What Next?

We need to stop assigning blame and ask ourselves how we are going to make our health care work; it will take a bipartisan effort.

Citations

  1. Legislative Actions in the 112th, 113th, and 114th Congress to Repeal, Defund, or Delay the Affordable Care Act
  2. The Senate Parliamentarian Seems Open to Robust Obamacare Repeal
  3. The Ongoing Political Strategy to Break ObamaCare
  4. Individual Insurance Market Performance in Early 2017
  5. ObamaCare Death Spiral and the Idea Democrats Forced the ACA Through are Myths
  6. Are Able-Bodied Adults Taking Advantage of Medicaid?
  7. Trump’s Attempts to Sabotage Obamacare Are Working
  8. Did the ACA Lead to High Medical Costs?