These days the debate is not about whether Obamacare's individual health insurance market is failing, it's about whose fault it is.
With a growing list of health plans pulling out of the Obamacare insurance exchanges or announcing big rate increases, it is clear that the individual health insurance market is not sustainable in its present form.
So, the terms of the debate have shifted. Where before supporters and opponents debated whether or not the law was working, now the debate is over whose fault it is that it is failing.
Supporters of the law apparently are now willing to admit that it is failing but that it's Trump's fault:
A few examples:
- "Increases like that will probably will be seen in other states, too, as insurers set prices to account for uncertain support from a federal government led by a new president who wants to scrap and replace the law," said Sabrina Corlette, a research professor at Georgetown Health Policy Institute.
- "In case you missed it, last week saw the debut of Trumpcare," said Washington Post columnist Dana Milbank. "The previous health care system, Obamacare, wasn't repealed. It was re-accommodated, United Airlines-style: bloodied, knocked silly and heaved aside. What has replaced it — a system of confusion and retreat — is entirely the doing of one Donald J. Trump."
- "The evidence is strong that the ACA is not dying of natural causes, but with the president's recent comments it's clear that it could die of suspicious causes," says Larry Levitt, a senior vice president at the Kaiser Family Foundation.
- "The problem going forward, and the problem now" said Obamacare architect Ezekiel Emanuel, "is ... the uncertainty today. That uncertainty today is created by the Trump administration because they haven't done three fundamental things."
What these Obamacare supporters are referring to are the steps that the Trump administration has taken or threatened to take to undermine the Obamacare insurance exchanges. They include:
- Directing the IRS to effectively not enforce the individual mandate and its penalty tax for not having coverage by continuing to process tax forms that do not answer the question about whether or not the filer has health insurance.
- Threatening to cut off $7 billion in annualized health insurance subsidies paid to the participating health plans to offset the costs of the reduced deductibles and co-pays the health plans are required to provide to lower income participants.
- Reducing open-enrollment advertising in the last few days of the January 2017 open enrollment.
Add to these things the Republican Congress' prior refusal to fully fund the insurance company reinsurance fund—which ended in 2016 anyway—and what's happening now all comes down to the fault of the Republicans.
Each of these actions or threats in fact has had an impact on the insurance companies contemplating their 2018 rates. How much? My conversations with health plans indicate that the impact may be as much as a third of any potential increase–a 30 percent increase might have been a 20 percent increase if Hillary Clinton were president right now.
But Hillary Clinton isn't president.
Donald Trump once again in an interview on Thursday pointed out that "we don't have to subsidize" Obamacare and that the recently passed spending bill which extended subsidies "only gives them one month."
Why does he do this?
Obamacare is in enough trouble on its own. Health plans are exiting and getting ready to give another round of big rate increases mostly because of the condition of the individual health insurance market that was already bad enough before Trump took office.
And, his comments beg another question: If he and his administration think Obamacare is "exploding" why do they need to add more fuel to the explosion?
All Trump and his administration are doing is giving their political opponents ammunition to argue that Obamacare was just fine before Trump showed up and wrecked it.
I offered the president some unsolicited advice in a recent column: "I would do everything from a regulatory perspective Nancy Pelosi is telling you to do to support the exchange markets. In fact, invite her in to give you the list. There aren't enough regulatory opportunities to fix this anyway. Having done that, how could the Democrats then argue a blowup was your fault?"
Well, Trump is unlikely to take my advice, so Obamacare supporters now have plenty of ammunition to blame Trump for its demise.
And that won't go over well in 2018 or 2020.
Commentary by Robert Laszewski, the president of Health Policy and Strategy Associates, LLC, who has twenty years of experience in the insurance industry, serving as a chief operating officer for nine of those years, before beginning his Washington, D.C. policy and market consulting business.
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