President Trump hasn't succeeded in repealing Obamacare yet. But his administration is doing its best to force the law to fail.
The most critical time of the year for the health care law is almost here: open enrollment, when millions of people log on to online marketplaces, check whether they qualify for federal subsidies to help them pay their premiums, and shop for plans. For the past three years, at least 10 million people have gotten insurance that way each year.
But this year, open enrollment is in the hands of a White House that's openly hostile to the Affordable Care Act — and the Trump administration is taking advantage of the best opportunity it has to undercut the law.
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President Trump has said that he wants Obamacare to implode, which he hopes would reignite the stalled congressional effort to repeal it. He isn't just sitting around waiting for that to happen. His administration halved the length of open enrollment. They slashed spending on advertising and assistance programs. They pulled out of outreach events at the last minute.
The entire health care law could be at stake. Advertising and outreach are primarily targeted to younger and healthier people, who are essential to the law's goal of affordable insurance coverage for all Americans. If their enrollment drops while older, sicker people keep signing up, premiums are going to increase even more next year.
It's the start of a death spiral, a self-perpetuating cycle of price hikes and falling enrollment — which is exactly what Trump has said he wants.
"I think what this cumulative activity can do is start that death spiral," Kathleen Sebelius, President Obama's health and human services secretary during the ACA's first open enrollment, told me.
Obamacare supporters are already conceding that as a result of these cuts, they likely won't be able to match last year's 12 million sign-ups. "I don't actually think that's possible anymore," Lori Lodes, who worked on Obamacare enrollment in the Obama administration, told me.
We will know by December 15, the end of this year's open enrollment period, how much the White House has succeeded in gutting Obamacare. By embracing this strategy, the Trump administration has put its political goals ahead of the millions of people who depend on the ACA for insurance.
"I really do think what they want to be able to do is come out on December 16 and say, 'See, we told you Obamacare is imploding; it's failing,'" Lodes said. "When the reality is they are going to be responsible because of the decisions they've made to undermine open enrollment."