The Trump administration has spent much of its first year in office trying to sabotage America’s health-care system. In interviews with major publications, Donald Trump repeatedly threatened to destabilize the Affordable Care Act marketplaces — by abruptly halting subsidies to insurers — as a means of eroding popular support for the law. Meanwhile, his Health Department spread doubt about whether it would enforce the tax penalty for refusing to sign up for insurance; cut funding for the law’s outreach groups; slashed Obamacare’s advertising budget by 90 percent; spent a portion of the remaining ad budget on propaganda calling for the law’s repeal; cut the open-enrollment period by 45 days; and announced that it would be taking Healthcare.gov (where people can enroll in Obamacare online) offline for nearly every Sunday during that time period, for “maintenance” purposes.
These acts of sabotage were never subtle. But until this week, Health and Human Services employees at least tried to maintain a veneer of (implausible) deniability. Sure, Tom Price’s department would evince contempt for the ACA — and all Americans who rely on it for basic medical needs — with virtually everything it did. But the agency’s civil servants wouldn’t actually say, explicitly, “My colleagues and I are working to undermine a program that we are legally bound to administer to the best of our abilities.”
That changed Wednesday night. Earlier in the day, BuzzFeed News revealed that the Trump administration had instructed the Health Department’s ten regional directors not to participate in state-based events promoting ACA enrollment, as they had for each of the past three years. After multiple outlets asked the agency for a comment on the move, HHS press secretary Caitlin Oakley offered the following:
Marketplace enrollment events are organized and implemented by outside groups with their own agendas, not HHS. These events may continue regardless of HHS participation.
Obamacare has never lived up to enrollment expectations despite the previous administration’s best efforts. The American people know a bad deal when they see one and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford. For the upcoming enrollment period, Americans are being hit with another round of double-digit premium hikes and nearly half of our nation’s counties are facing Obamacare monopolies. As Obamacare continues to collapse, HHS is carefully evaluating how we can best serve the American people who continue to be harmed by Obamacare’s failures. [Emphasis mine.]
So: Asked to respond to the allegation that it is deliberately undermining ACA-enrollment efforts — in defiance of its legal responsibilities — the Trump administration released a written statement explicitly discouraging Americans from enrolling in the program.
This is an expression of proud disdain for the president’s constituents, the most basic norms of good governance, and factual reality, all in one. Oakley is correct that Americans looking for coverage on the individual market will likely see double-digit premium hikes next year. But she neglects to mention that insurers — and the Congressional Budget Office — have said, repeatedly, that the primary cause of said hikes is the uncertainty generated by acts of sabotage like the one she is ostensibly defending.
If the Trump administration was worried about Obamacare’s rising premiums, it would be increasing investments in enrollment promotion, not slashing them. Sick people will tend to seek out health insurance, whether or not they’re exposed to advertising and events encouraging them to do so. But many healthy people will not. And the fewer healthy people who participate in the exchanges, the more expensive it will be for insurers to provide coverage for them — and, thus, the higher they will raise their premiums.
The administration’s handling of open enrollment is nearly as strategically incoherent as it is morally odious. All available polling suggests that most voters now trust Democrats more than Republicans on the issue of health care — and believe that Trump is responsible for any problems with Obamacare, going forward. Which makes sense: Historically, the public holds the president — and his party — accountable for virtually everything bad that happens on his watch. A large spike in premiums at the start of a midterm election year is in no one’s immediate interest — except, perhaps, Nancy Pelosi’s.
Ostensibly, the administration believes that the worse the status quo health-care system functions in early 2018, the easier it will be to revive — and pass — the GOP’s plans for radically reforming it. But manufacturing a crisis in the Obamacare marketplaces isn’t going to change the hard facts that the Republican Party is committed to slashing federal health-care funding — and the Congressional Budget Office will always find that large cuts to federal health-care funding will make the status quo worse for millions of people.
The most rational explanation for the administration’s behavior is that it is putting the long-term conservative goal of discrediting government involvement in health care above the near-term political interests of the Republican Party.
Obamacare was the largest expansion of the welfare state in decades. And for all its shortcomings and travails, the law has already popularized the idea that the government has a responsibility to guarantee affordable health care for all. Many Republicans (including the president) recognized that there was little electoral gain in rejecting this premise, so they attacked Obamacare for failing to live up to the progressive ideal. This left them ill-equipped to defend legislation that pushed their true agenda (throwing millions of people off of health insurance in order to finance tax cuts for millionaires). Having failed to discredit the ideal of universal health care on the campaign trail or in Congress, conservatives can still try to undermine its viability by making Obamacare work as poorly as possible.
But even on these terms, the administration’s gambit is dubious. Much to the surprise of some of Obamacare’s architects, the law’s expansion of Medicaid has proven considerably more popular — and unequivocally successful — than the insurance exchanges. By sabotaging the most market-oriented part of the ACA, the Trump administration may further heighten this discrepancy — and, thus, lend further credence to the idea that “big government” programs are better at delivering health care than public-private partnerships.
It is deeply unsettling that our government is comfortable openly flouting its responsibilities and undermining public services in pursuit of an ideological project that has no popular mandate. But there is some consolation in the thought that Trump’s band of cynical saboteurs are, ultimately, sabotaging themselves.