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The Trump administration’s latest steps to undermine the Affordable Care Act, explained

Federal officials are slashing funding for enrollment assistance 70 percent.

The Trump administration keeps rolling back support for the Affordable Care Act.
Trump and his administration are staging a multifaceted campaign to undermine Obamacare.
Tatyana Zenkovich/AFP/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

With another period of Obamacare open enrollment soon to begin, the Trump administration is once again dramatically scaling back outreach for the health care law.

The Centers for Medicare and Medicaid Services announced a 70 percent cut — $26 million — to the “navigators” program that hires people to help qualified individuals sign up for insurance through Obamacare. That follows a 40-percent cut last year. From the last year of the Obama administration to the second year of Trump’s, navigator funding has fallen from $62.5 million to a mere $10 million.

This is, of course, just one front in the Trump administration’s multifaceted undermining of the Affordable Care Act even while Republicans in Congress have failed to repeal it. Trump officials have also almost entirely ended advertising for Obamacare but are expanding access to skimpier health plans that will likely weaken the law’s markets.

Administration officials defend the navigator cuts as fiscally responsible. And it is true that Obamacare had relatively strong sign-ups for 2018 — just a slight dip to 11.8 million people enrolled from the 12.2 million in 2017 — despite the outreach cuts made by the White House.

But things aren’t likely to get any better as the Trump administration keeps rolling back support for the ACA. The law has proved durable, but it has also failed to fully escape peril. Just in the last few weeks, the Trump administration froze critical payments to health insurers while the Justice Department has argued that the law’s protections for preexisting conditions should be ruled unconstitutional in federal court.

The uncertainty fostered by all this in turn drives up insurance premiums, which for 2019 will be finalized in October, shortly before voters head to the polls for the 2018 midterm elections.

Navigator and advertising funding are almost gone

The Trump administration has now all but eliminated Obamacare’s outreach budget. In 2017 the Centers for Medicare and Medicaid Services slashed the budget for TV, digital, and other advertising 90 percent — from $100 million to $10 million — and cut navigator funding nearly in half. The agency mostly finished the job this week, announcing that the navigators budget would shrink to just $10 million for the upcoming open enrollment period.

There is some academic evidence that advertising cuts lead to enrollment losses, and Obamacare enrollment did drop for 2018 although one would otherwise expect it to keep rising every year. In some states like Louisiana — where the uninsured rate still hovers above 10 percent despite the gains made after the ACA’s passage — the Trump administration effectively erased the navigator presence. Thisis only going to worsen after the next batch of cuts.

Trump administration officials can point to last year’s relatively strong sign-ups numbers to justify the cuts, but the truth is the administration has also pulled out of outreach events that don’t cost millions of dollars. The clear message from the White House is that the ACA will receive the absolute minimal amount of support from the administration. After all, the president has tried to tell the American people that the law is dead.

The myriad other ways Trump has undermined Obamacare

Trump administration officials have done more than cut Obamacare outreach, of course: They have also sought to expand skimpier, noncompliant coverage options. They do this in the name of providing people cheaper insurance and this may be work for younger, healthier and a little better-off people. But for those individuals who actually need robust health insurance, it might not be a viable option.

At the same time Trump’s actions keep increasing premiums inside the ACA markets, so that many people — particularly individuals who make too much money to receive federal assistance — are left to choose between buying less comprehensive coverage or shelling out for ever-rising premiums.

Trump has taken a couple of routes toward this goal, allowing people to buy “short-term” insurance, which lasts for a whole year and doesn’t need to satisfy Obamacare’s rules, while also making it easier for the establishment of “association health plans,” which are not subject to some of the ACA’s mandates. Actuaries expect these new regulations, particularly those for the short-term insurance, to tack on as much as 10 percent to insurance premiums next year.

Trump’s sabotage increases insurance premiums

The president isn’t responsible for the price hikes of Obamacare’s first few years. Insurers often have underestimated the costs of serving the law’s customer base, and the individual mandate wasn’t as effective as some officials had hoped at pushing healthier people into the market.

But the law’s markets had been stabilizing until Trump’s intervention. All the new Trump policies are working in tandem to drive up the costs of Obamacare — as did the president’s decision to end Obamacare’s cost-sharing reduction payments to insurers last year and the Republican repeal of the individual mandate in the tax law. Premiums are still rising by the double digits on average across the country because of Trump’s and the GOP’s actions.

These hikes can hurt the law only so much. Ten million or so customers are mostly inoculated from those increases by federal subsidies. Instead federal taxpayers pick up the bill. But the people who make a little too much money while actually needing robust insurance find themselves in a tough spot.

As was the case last year, the newly announced cuts to Obamacare’s navigators won’t result in the end of the law. But they are yet another ding — at the same time that the law is facing an existential legal challenge supported in part by Trump’s Justice Department. Some different key payments to insurers were also frozen recently because of an ongoing court case.

Insurers hate uncertainty, and the Obamacare markets, upon which millions of Americans rely for health coverage, suffer as a result.

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