Is
Trumpcare finally dead? Even now, it’s hard to be sure, especially
given Republican moderates’ long track record of caving in to extremists
at crucial moments. But it does look as if the frontal assault on the
Affordable Care Act has failed.
And
let’s be clear: The reason this assault failed wasn’t that Donald Trump
did a poor selling job, or that Mitch McConnell mishandled the
legislative strategy. Obamacare survived because it has worked — because
it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains.
Unfortunately,
some of those gains will probably be lost all the same: The number of
uninsured Americans is likely to tick up over the next few years. So
it’s important to say clearly, in advance, why this is about to happen.
It won’t be because the Affordable Care Act is failing; it will be the
result of Trump administration sabotage.
Some
background here: Even the A.C.A.’s supporters have always acknowledged
that it’s a bit of a Rube Goldberg device. The simplest way to ensure
that people have access to essential health care is for the government
to pay their bills directly, the way Medicare does for older Americans.
But in 2010, when the A.C.A. was enacted, Medicare for all was
politically out of reach.
What
we got instead was a system with a number of moving parts. It’s not as
complex as all that — once you understand the basic concept of the “three-legged stool”
of regulations, mandates and subsidies, you’ve got most of it. But it
has more failure points than, say, Medicare or Social Security.
Continue reading the main story
ADVERTISEMENT
Continue reading the main story
Notably,
people aren’t automatically signed up for coverage, so it matters a lot
whether the officials running the system try to make it work, reaching
out to potential beneficiaries to ensure that they know what’s
available, while reminding currently healthy Americans that they are
still legally required to sign up for coverage.
You can see this dependence on good intentions by looking at how health reform has played out at the state level. States that embraced the law
fully, like California and Kentucky, made great progress in reducing
the number of the uninsured; states that dragged their feet, like
Tennessee, benefited far less. Or consider the problem of counties
served by only one insurer; as a recent study noted, this problem is almost entirely limited to states with Republican governors.
But
now the federal government itself is run by people who couldn’t repeal
Obamacare, but would clearly still like to see it fail — if only to
justify the repeated, dishonest claims, especially by the tweeter in
chief himself, that it was already failing. Or to put it a bit
differently, when Trump threatens to “let Obamacare fail,” what he’s
really threatening is to make it fail.
On Wednesday The Times reported
on three ways the Trump administration is, in effect, sabotaging the
A.C.A. (my term, not The Times’s). First, the administration is
weakening enforcement of the requirement that healthy people buy
coverage. Second, it’s letting states impose onerous rules like work
requirements on people seeking Medicaid. Third, it has backed off on
advertising and outreach designed to let people know about options for
coverage.
Actually, it has done more than back off. As reported by The Daily Beast,
the Department of Health and Human Services has diverted funds
appropriated by law for “consumer information and outreach” and used
them instead to finance a social media propaganda campaign against the
law that H.H.S. is supposed to be administering — a move, by the way, of
dubious legality. Meanwhile, the department’s website, which used to
offer helpful links for people seeking insurance, now sends viewers to
denunciations of the A.C.A.
And
there may be worse to come: Insurance companies, which are required by
law to limit out-of-pocket expenses of low-income customers, are already
raising premiums sharply because they’re worried about a possible cutoff of the crucial federal “cost-sharing reduction” subsidies that help them meet that requirement.
The
truly amazing thing about these sabotage efforts is that they don’t
serve any obvious purpose. They won’t save money — in fact, cutting off
those subsidies, in particular, would probably end up costing taxpayers more money than keeping them. They’re unlikely to revive Trumpcare’s political prospects.
So
this isn’t about policy, or even politics in the normal sense. It’s
basically about spite: Trump and his allies may have suffered a
humiliating political defeat, but at least they can make millions of
other people suffer.
Can
anything be done to protect Americans from this temper tantrum? In some
cases, I believe, state governments can insulate their citizens from
malfeasance at H.H.S. But the most important thing, surely, is to place
the blame where it belongs. No, Mr. Trump, Obamacare isn’t failing; you are.
Posts
No comments:
Post a Comment