This post has been updated with Trump's new executive order.
Two weeks ago, Republicans failed for the final time to repeal and/or replace Obamacare with their own health-care bill. And now that any changes will require 60 votes rather than 50, efforts are progressing to overhaul the law on a bipartisan basis.
But poison may be seeping into the well, thanks to the Trump administration's increasingly indisputable efforts to undermine the law.
On Thursday morning, President Trump is set to sign an executive order that will scale back Obamacare's regulations and make it easier to buy plans that don't meet the Affordable Care Act's requirements. Included in the new package is a rewriting of the rules for “association plans,” in which small-businesses join together to negotiate benefits. Also included are a lengthening of short-term policies with less coverage from three months to nearly a year, and an expansion of the use of pretax dollars for any medical expenses — not just policies that meet the ACA's requirements.
Critics worry that such moves will reduce enrollment in the Obamacare marketplace plans and drive up costs, further imperiling the law. And these are hardly the first examples. The administration previously flirted with cutting off subsidies for insurers who assist low-income customers. And, as The Post's Juliet Eilperin notes, the Department of Health and Human Services has cut the next enrollment period in half, made the HealthCare.gov website less available, reduced the advertising budget by 90 percent and cut funding for the groups that sign people up for coverage.
Last week came two more examples of this trend:
- The Washington Post reported that the Republican-controlled Iowa state government approached the Department of Health and Human Services for help stabilizing its embattled health-insurance marketplace, but President Trump personally told the department not to help.
- The administration issued a new rule Friday making more insurers and employers exempt from having to provide free birth control, potentially taking that benefit from hundreds of thousands of beneficiaries.
In case there was any doubt about what the administration is doing, this comment a couple weeks back from a Department of Health and Human Services spokesperson should put it to rest:
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.
Judging by that statement and the moves described above, it's clear the Trump administration isn't going to lift a finger to salvage the law and make it workable for the foreseeable future. It seems anxious, in fact, to usher in its demise.
If you truly believe Obamacare is failing and that the whole thing is throwing good money after bad, that may seem like a justifiable thing to do. As a political strategy, it could also apply pressure on lawmakers to come up with a bipartisan fix sooner than later. And it could serve to reinforce the law's problems in the minds of voters.
But if you're a Democrat preparing to work with congressional Republicans and the administration on fixes to Obamacare, it has to give you pause. The law's proponents are increasingly exasperated by what they feel is the administration failing to act in good faith and not attempting to make the current situation work. Some have labeled it “sabotage.”
There seems to be some progress on the deal being negotiated by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). But at this point, you have to wonder how much faith Democrats have in the administration to faithfully implement whatever is negotiated. And at the very least, this is injecting some passionate disagreements into a debate that requires the two sides to come together.