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Morning Briefing

Summaries of health policy coverage from major news organizations

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Monday, Oct 16 2017

Full Issue

Tough Talk: Trump's Open Warfare Against Obamacare; Ideas That Deepen Health Care 'Inequality'

Across the country, editorial and opinion writers offer tough talk about the Trump administration's actions last week to loosen some health insurance restrictions and to stop federal payments for cost-sharing reductions under the Affordable Care Act.

Since Donald Trump鈥檚 election, a loose coalition of citizens, doctors, nurses, activists and others have rallied together to prevent their fellow Americans from losing health insurance. They won a big victory last month when Congress set aside its efforts to pass a destructive bill. But now the coalition has a new fight. Trumpcare has begun, not through legislation but through executive action. (David Leonhardt, 10/15)

The Trump administration has declared open war on the Affordable Care Act. With its abrupt decision to terminate critical subsidies, it has thrown the exchanges into chaos on the eve of open enrollment; it has imperiled the full faith and credit of the United States; and it will cause a massive increase in federal spending. This is no way to run a healthcare system, and no way to run a government. (Nicholas Bagley, 10/13)

President Trump鈥檚 decision to stop paying subsidies to insurance companies that cover many low-income Americans is his most overt action so far to undermine the Obamacare markets, which reopen for sign-ups on Nov. 1. But the timing of the announcement, late Thursday night, means the ending of subsidies may be less disruptive than it might have been months ago, when he began threatening such action. It still could cause insurers to leave some Obamacare markets and places where customers have no insurance choice, but it probably won鈥檛 cause the widespread meltdown it might have, if it had happened earlier this year. (Margot Sanger-Katz, 10/13)

Most of Congress鈥 remarkable streak of failed attempts to 鈥渞epeal and replace Obamacare鈥 at least pretended to follow through on the 鈥渞eplace鈥 half of the promise. President Trump鈥檚 administrative ambush of the law this week dispensed with that pretense and laid bare his ill will: to dismantle President Barack Obama鈥檚 health care reform without regard for what follows. (10/13)

President Trump鈥檚 actions on Obamacare will accelerate a recent trend toward dividing the individual health insurance market between the healthy and those with chronic illness and between the wealthy and the poor. The immediate elimination of cost-sharing-reduction subsidies will have a great impact. These subsidies lower the out-of-pocket expenses for individuals who earn between 100 percent and 250 percent of the federal poverty level. About seven million people qualified for C.S.R.s, according to the Kaiser Family Foundation. (David Anderson, 10/13)

Let鈥檚 set aside for the moment President Trump鈥檚 decision to end Obamacare鈥檚 cost-sharing reduction payments (CSRs) to insurers, a system under which insurers are subsidized to help keep costs low for low-income insurance recipients. Let鈥檚 also set aside the other ways in which the Trump administration has been deliberately undermining enrollment in the Obamacare marketplaces. We鈥檒l set aside that the administration has slashed funding to outreach programs by as much as 92 percent, ended partnerships with state groups aimed at getting people enrolled, cut funding for advertising the enrollment period and even decided it would shut down the enrollment website for 12 hours a week for maintenance. (Philip Bump, 10/13)

President Donald Trump issued a sweeping executive order on Thursday that may help lower costs and create more options for many Americans who struggle to find health insurance. But we learned later Thursday that he also is poised to halt billions in subsidy payments to insurance companies that help cover medical costs for millions of low-income Americans. (10/13)

Yesterday, October 12, 2017, the White House press office announced that the administration will no longer be reimbursing insurers for the cost-sharing reductions they are legally required to make for low-income individuals. The Affordable Care Act requires insurers to reduce cost sharing for individuals who enroll in silver plans and have household incomes not exceeding 250 percent of the federal poverty level. These provisions reduce the out-of-pocket limit for these enrollees鈥攑articularly for those with incomes below 200 percent of poverty鈥攁nd sharply reduce deductibles, coinsurance, and copayments. The reductions cost insurers around $7 billion a year currently. (Timothy Jost, 10/13)

Even after Republicans in Congress failed three times to rid themselves of the Affordable Care Act, President Trump has proved that there is no shortage of ideas for how to disrupt the health-care system. The president signed an executive order Thursday that will allow small employers to join associations of small business 鈥 such as farm bureaus or chambers of commerce 鈥 that provide health coverage to their members. If such associations self-insure, existing law might enable them to avoid both state insurance regulations and the core of the ACA. Thus, a simple turn of the regulatory dials could free up a large portion of the most heavily regulated parts of the health-insurance market. (Mark A. Hall, 10/13)

The conventional wisdom is that Donald Trump's decision to suspend the federal subsidies insurers say are vital to the survival of Obamacare is simply the latest manifestation of the current president's contempt for everything associated with his predecessor. Haters gonna hate, after all. And who hates anything more passionately than 45 hates 44? (Brian Dickerson, 10/16)

Donald Trump and fellow Republicans spent much of the Obama administration complaining about how the president was legislating by the fiat of executive order, bypassing Congress and undermining existing law. So what has President Trump done with his latest actions on the Affordable Care Act? Legislate by fiat, bypass Congress and undermine existing law. (10/15)

Despite President Trump鈥檚 best efforts, the Obamacare market hasn鈥檛 imploded yet. While Thursday鈥檚 decisions to cut off government funding and invite competition from flimsier, cheaper plans will jostle a vulnerable market, many of the major insurance companies say they will remain in the state marketplaces next year. (Reed Abelson and Margot Sanger-Katz, 10/13)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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