President-elect Donald Trump screamed loud and clear he would eliminate the Affordable Care Act (mess of Obamacare) on day one of his presidency. But like all politicians in the heat of a campaign, Trump has said many things he is already toning down modifying rhetoric for reasonable and cooperative solutions that could garner bi-partisan support.
But there is plenty he could do. The president-elect does not have to deal with Congress. Trump could immediately cancel “cost-sharing reductions,” the payments that help low-income Obamacare enrollees afford their deductibles.
He could, but most likely won’t. House Republicans have already sued the Obama administration over these payments. They argue these are being made unconstitutionally because Congress has not provided an appropriation for them. A Trump administration could simply drop its defense in that lawsuit in court and cancel the payments, period.
Trump could also take other steps that would immediately disrupt coverage for many of the 20 million people who have gained healthcare under President Obama’s law. But shortly after his stunning victory, Trump promised on to “fix healthcare” during a visit to Capitol Hill. That came with scant details of what his plans will be if he desires to repeal Obamacare.
The president-elect and Republicans can argue the law has reduced choices with heavy regulations and led to rising premiums. Americans have already discovered that fact. Trump could actually hurt the Affordable Care Act by doing essentially nothing at all, and that is a fact.
Insurers have complained bitterly about smaller and sicker group of enrollees than expected. Yes, the Obama administration had been working to address those concerns, but with no real success. The Trump administration could discard those efforts allowing more insurance companies to drop out in 2018. That would narrow options for people and possibly leave some areas of the country with no ability to get Obamacare insurance, period.
The reality is Trump will be sworn in just 11 days before Obamacare’s annual sign-up period. That entails an intense outreach effort encouraging people to sign up. Trump has the option to shelve that situation, potentially shrinking enrollment. Any recourse Trump takes comes along with a parallel effort in a majority-led Republican Congress to repeal the law.
This will all take months. The reality is Republicans don’t have the required 60 votes in the Senate to repeal the law under the normal process. That means they will most likely use a complicated special process called reconciliation to allow the measure to pass with a simple majority. That is the logical way to address this critical concern for the country at large.
It will give Republicans time to try to come up with a replacement. It poses a risk to Trump’s early presidency. He could face political backlash for disrupting healthcare for people if he does not wait for Congress to act and provide a transition.
A Trump administration would likely decline to settle with insurers. Trump could also redirect away some funds under a program called reinsurance. All these actions would worsen insurers’ financial situation and could lead to premium hikes for 2018 or insurers simply dropping out. Trump is in a conundrum.
Nicholas Bagley, a law professor at the University of Michigan who tracks the Affordable Care Act said in a recent interview, “Insurers are going to be pretty reluctant to participate in 2018 unless and until they have some certainty. Thus, the cost-sharing reductions are an obvious starting point for Trump. Therein may be the talent of a businessman who controls a vast real estate empire. He has been there, done that.”
Yet that step would cause major turmoil in the health law’s marketplaces. Insurers would still be required to give discounts to low-income people. They would just no longer get reimbursed by the government through the cost-sharing reduction payments, blowing a hole in their budgets. Is that sustainable until a pragmatic, bi-partisan solution be reached?
Unless the billionaire mogul can negotiate an agreement with insurers, they might decide to just drop out of Obamacare in the middle of the year, leaving their enrollees stranded, if the payments were canceled.
It will be interesting as the lame duck period of Barack Obama’s eight year reign can be bandaged together long enough for a peaceful exit into a Trump administration over this pressing problem.
Will the left-leaning media support new measures that are not to their personal liking? Will Americans give Trump the time necessary to figure out the variety of messes he faces.
