America Is Getting Trumpcare Anyway

With Republicans unable to destroy Obamacare in Congress, Trump is simply going to do it for them through applied executive branch neglect, and he really no longer cares what the American people have to say about it.

Trump is asking federal agencies to look for ways to expand the use of association health plans, groups of small businesses that pool together to buy health insurance, and to broaden the definition of short-term insurance, which is exempt from the Affordable Care Act’s rules, administration officials said. 

The ultimate impact will depend on any new regulations written as a result of the order, but overall, the Trump administration could make cheaper plans with skimpier benefits more available — and experts worry that will damage the ACA’s marketplaces. 

“The president still firmly believes that Congress must act to repeal and replace Obamacare, but before that can be done, this administration must act to provide relief,” Andrew Bremberg, who oversees domestic policy at the White House, told reporters Thursday morning. “We expect these policy changes to potentially benefit tens of millions of Americans over time.” 

Policy experts warn that together, these changes could represent a serious threat to Obamacare: Trump wants to open more loopholes for more people to buy insurance outside the health care law’s markets, which experts anticipate would destabilize the market for customers who are left behind with higher premiums and fewer insurers. 

The fear is that Trump’s action could lead to many association health plans being exempted from core Obamacare requirements like the coverage of certain essential health benefits. It could also potentially allow some individuals to join these plans too, which could hurt the individual insurance marketplaces by drawing younger and healthier people away from them. In much the same way, short-term insurance could also take healthier people out of the law’s markets. 

The effect won’t be immediate: Administration officials said they didn’t expect any new regulations to be implemented before the end of the year. But Trump’s order does present a long-term risk to the ACA. 

“The clear intent of the executive order is to create a parallel insurance market exempt from many of the consumer protections in the Affordable Care Act,” Larry Levitt at the Kaiser Family Foundation told me. “This has the potential to siphon off healthy people with skinnier benefits and cheaper premiums, leaving behind a sicker pool of people under ACA plans.”

The long-term goal is to collapse the individual market and then Congress will have no choice but to put a health care "reform" Trump will sign on his desk.  Sure it'll wreck the lives of tens of millions, but who cares, right?

But then this morning Trump completely blew up the Obamacare exchanges by cutting off subsidy payments to insurers to lower premiums.

The subsidies, which are worth an estimated $7 billion this year and are paid out in monthly installments, may stop almost immediately since Congress hasn’t appropriated funding for the program.

The decision, which leaked out only hours after Trump signed an executive order calling for new regulations to encourage cheap, loosely regulated health plans – delivered a double whammy to Obamacare after months of failed GOP efforts to repeal the law. With open enrollment for the 2018 plan year set to launch in two weeks, the moves seem aimed at dismantling the law through executive actions.

Press Secretary Sarah Huckabee Sanders confirmed the decision in a statement emailed to reporters at 10:47 p.m. Thursday.

“Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare,” she said. “In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments. …The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system.”

Who will be hurt by this? Sure, this is going to harm red state Trump voters, but the biggest problems will be in states that expanded Medicaid. After all, the majority of those who will suffer aren't Trump voters, but blue states who already raised premiums for 2018 because they saw what was coming.

Threats by President Donald Trump to ax crucial payments to health insurers will double, on average, the price of most Obamacare plans in California next year. 

Obamacare officials in the Golden State on Wednesday said they are slapping a 12.4 percent surcharge on the prices of so-called silver individual health plans in 2018 because of uncertainty over whether Trump will continue making those payments.
And it will be taxpayers, not the insurance customers themselves, who will end up footing much of the bill.

Without the surcharge, silver plans sold on Covered California, the state's Obamacare marketplace, would have risen an average of just 12.5 percent next year, officials said as they revealed overall prices statewide.

With the surcharge, the average price hike is just shy of 25 percent. 

For individual insurers, the actual added surcharge per plan will be anywhere from 8 percent to 27 percent. 

About 6 out of 10 customers of Covered California are enrolled in silver plans, which cover 70 percent of enrollees' health costs. 

Covered California said that even with the surcharge, 78 percent of customers who qualify for federal subsidies to reduce their monthly premiums will "either see no change in what they would pay for insurance in 2018, or would pay less than what they would have paid if there had been no ... surcharge." 

That is because the value of those premium subsidies, which are in the form of federal tax credits, rises with the retail price of the health plan. In "many" cases, Covered California said, subsidized silver plan customers will see their subsidies rise more than the amount of the surcharge.

And those payments will go away completely should the GOP have their way, along with Medicaid expansion.  California would then be on the hook for tens of billions yearly to keep these plans up. Even if the GOP can't pass a plan, by wrecking the individual market, Trump can make sure there are no plans to offer other than the garbage plans the GOP has favored all along.

Trump can just blame Obamacare for being broken, even though he's the one swinging the sledgehammer.

And so it goes.