On Friday Oct. 13, the Trump administration announced it will stop funding key subsidies that help low-income Americans afford their deductibles and copays. Experts say the move could force insurers to absorb large losses or leave the marketplace altogether. Experts characterize the decision, which comes just one day after President signed an executive order expected to raise marketplace premiums, as one of many efforts by the Trump administration to undermine the 2010 health-care law.
Here are points in the process the administration has affected the marketplace’s operation so far:
ROADBLOCK Trump has decided to end key subsidies
On Friday the Trump administration announced it will stop paying cost-sharing reductions, subsidies that help offset low-income Americans’ deductibles and co-pays. Insurers in some states already raised premiums or added surcharges to account for this possibility. But many others will be faced with a choice: absorb the cost of losing the subsidies, or pull out of the marketplace completely.
ROADBLOCK Trump might not strictly enforce ACA's mandate to buy insurance
Whether federal officials strictly enforce the individual mandate, which requires taxpayers to provide proof of health care coverage, also affects insurers’ pricing. The more it’s enforced, the more likely it is healthy people will enroll, which in turn lowers insurers’ costs and what they charge for premiums.
ROADBLOCK HHS is not helping states plan for enrollment season
Every year, the Department of Health and Human Services has sent regional directors to help states get up and running for open enrollment. This year, they’re not coming.
ROADBLOCK Trump has slashed the ACA advertising budget
The administration announced it would spend $10 million on advertising open enrollment, one-tenth what the Obama administration spent last year. That could mean fewer people will hear about the enrollment period.
2017 budget: $100 million
2018 budget: $10 million
ROADBLOCK He also cut funding for ACA ‘navigator’ groups
ACA navigators tell people in their community about the open enrollment period and help them sign up for the exchanges. The Health and Human Services Department is slashing the navigator budget by 40 percent overall, up to 92 percent in some places. Some navigator organizations have already shut down as a result. Read more about this cut here.
ROADBLOCK HHS has put out negative advertising about the marketplaces
The Trump administration has advertised against the ACA. By emphasizing messages that the market is imploding or the plans are too costly, the administration has discouraged people from enrolling.
ROADBLOCK Trump is expanding eligibility for joining “association health plans”
These plans would allow people to buy cheaper, less comprehensive insurance than is offered in the ACA marketplaces. Experts expect it to pull healthy people out of the marketplaces, increasing average costs and therefore premiums.
ROADBLOCK The administration cut the open enrollment period in half
The open enrollment period, when people are able to sign up for the exchanges, used to span from Nov. 1 to Jan. 31. The Trump administration cut this in half, ending the period on Dec. 15. A spokesperson for HHS said this is because Obamacare missed its enrollment targets in the past. And beyond that, Healthcare.gov is being shut down for several hours most Sundays. Since people have less time to enroll, it’s likely that fewer people will get the message in time.
Healthcare.gov plans to accept
part of the
Last year’s open enrollment: Nov. 2016—
This year’s open enrollment: Nov. 2017—
part of the day.
Healthcare.gov plans to to accept enrollment
Last year’s open enrollment
This year’s open enrollment
ROADBLOCK The shorter enrollment will put more strain on Healthcare.gov
As it stands, Healthcare.gov has a hard time handling the surge of traffic in mid-December (so people can get insurance starting in the new year) and the end of January (so people can make the deadline). By changing the open enrollment period, these two surges will occur simultaneously in mid-December, according to Karen Pollitz of the Kaiser Family Foundation. Since there’s no signs the technology will be upgraded, this could cause the website to crash.
Kevin Uhrmacher contributed to this report.