At its heart, the Affordable Care Act — Obamacare — is about figuring out how to pay to provide more people with insurance coverage. Before the policy was enacted, insurers balked at covering those with preexisting conditions for the simple reason that such customers are expensive. Cover a lot of expensive people and you either need to enroll more healthy people (who will pay premiums but use fewer resources) or raise premiums.
Obamacare opted for the former, mandating that Americans have health insurance or pay a tax penalty. Without those healthy people paying into the system, insurers that have to provide coverage for those with preexisting conditions might be left with no choice but to increase premiums.
In other words, enrolling those healthy people is central to making Obamacare work. And in light of that, it’s probably not surprising to discover that the administration of President Trump is taking a number of steps that, intentionally or not, will undercut the number of healthy people who enroll.
Here are a number of ways that’s happening.
Slashed funding for enrollment groups. Earlier this month, The Post reported that navigator groups — organizations that work to enroll participants in Obamacare in states that don’t operate their own insurance exchanges — would see sharp cuts to the funding they receive from the federal government. Some groups saw reductions of as much as 92 percent of what they’d received in the past, part of the administration’s decision to cut funding overall by 41 percent.
The biggest cuts, we learned, were to groups in the South and the Midwest. Nebraska will lose 81 percent of its funding; Indiana, 82 percent; Louisiana, 80 percent. Among the populations targeted by navigator groups are young people, a population that tends to be much healthier on average, for perhaps obvious reasons. Thirty-five organizations in 21 states targeted young people specifically.
Cut funding for enrollment advertising. The administration announced plans to cut its advertising budget for enrollment from $100 million to $10 million at the end of August — a 90 percent decrease. As Vox subsequently reported, a sharp decrease in advertising in Kentucky after that state elected a Republican governor led to a big drop-off in visits to the enrollment website in the state.
“Our analysis tells us that state-sponsored television advertising was a substantial driver of information-seeking behavior in Kentucky during open enrollment,” a report on the cuts read, “a critical step to getting consumers to shop for plans, understand their eligibility for premium tax credits or Medicaid, and enroll in coverage.”
Shutting down the enrollment website for hours a week. The open enrollment period for 2018 runs from Nov. 1 to Dec. 15, the critical period during which enrollment is encouraged. Last week it was revealed that for 12-hour blocks on several Sundays during that period, Healthcare.gov would be down for maintenance. The only Sunday on which the site isn’t scheduled to be down from midnight to noon is on Dec. 10, the last Sunday of enrollment.
Halted participation in enrollment events. Talking Points Memo noted in August that a Latino group that had worked with the Department of Health and Human Services in past years to enroll people in Obamacare suddenly found itself shut out. While the administration of President Barack Obama had provided Spanish-language materials and sent surrogates to events to encourage enrollment, that stopped in 2017.
“We haven’t had any of those discussions,” the policy director of one group told TPM. “It almost completely stopped as soon as the new administration came in.”
This week, a similar report from Mississippi. Vox’s Dylan Scott learned that an organization in that state that had similarly worked with HHS in the past to put together events would not be receiving any such help from the federal agency in 2017. The Mississippi Health Advocacy Program had expected agency staff to participate in events aimed at encouraging enrollment across the state and, as recently as this month, had received confirmation that the partnership would move forward. Then, on Monday, it received notice that no HHS staff would be participating.
Asked for comment, a spokesman for HHS told Vox that 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.”
The measures above are likely to hurt enrollment numbers — helping to push Obamacare toward just such a point of failure.