The Washington PostDemocracy Dies in Darkness

Opinion Americans are starting to suffer from Trump’s health-care sabotage

President Trump's health-care actions could have ripple effects throughout the Affordable Care Act's marketplaces. (Video: Jenny Starrs/The Washington Post, Photo: Jabin Botsford/The Washington Post)

IT IS a tribute to the resilience of the United States’ public and private institutions that, despite President Trump’s incoherent management, the country has, by many measures, continued to improve, notching its lowest unemployment rate since 2000 in the latest federal employment update. But the effects of the president’s underinformed instincts, enabled by the ideologues in his administration, are beginning to show up in some of the numbers, representing real pain that Americans are suffering for Mr. Trump’s deficient leadership.

The Commonwealth Fund, a nonprofit foundation focused on health-care issues, announced last week that the rate of working-age Americans without health insurance in the group’s annual survey rose to 15.5 percent, up about three percentage points since 2016. Things are worse in the 19 holdout states, such as Virginia, that have refused to expand their Medicaid programs: The rate of uninsured working-age Americans hit 21.9 percent in those areas, up nearly six percentage points over two years. Nationally, the spike has been particularly bad at the modest end of the income scale, rising nearly five percentage points since 2016 for low-income, working-age Americans.

Obamacare critics regularly describe all problems as the inevitable result of a poorly designed law. But the numbers suggest that the critics’ sabotage efforts are to blame. After impressive declines during President Barack Obama’s second term, the fund found that the uninsured rate increased in both of the years Mr. Trump has been in office. During the campaign, Mr. Trump regularly complained that the Affordable Care Act (ACA) left too many Americans uncovered. The result of nearly a year and a half of Mr. Trump’s leadership is 4 million people added to that group.

Obamacare was never perfect. But Commonwealth Fund analysts noted that, rather than fixing the law’s problems, Republicans have done concrete things to worsen them. “These include the administration’s deep cuts in advertising and outreach during the marketplace open-enrollment periods, a shorter open enrollment period, and other actions that collectively may have left people with a general sense of confusion about the status of the law,” they wrote. “Signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don’t comply with ACA minimum benefit standards, and support for Medicaid work requirements.”

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Former health and human services secretary Tom Price, an architect of the GOP’s anti-Obamacare campaign, admitted last week that repealing the law’s requirement that all Americans carry health coverage means that “you’ll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks within that market.” Indeed, the fund found that 5 percent of non-elderly adults plan to drop coverage in response to the mandate repeal. That number may seem small, but if it is younger and healthier people dropping out, it will raise costs for everyone else.

States must do their best to fill gaps. They can establish reinsurance programs that help insurers with high-cost patients, impose individual mandates within their own borders and run open-enrollment advertising campaigns of their own. In some states, at least, the misery of going without health insurance might be easier to avoid.

Read more:

The Post’s View: Three million more people are uninsured. Thanks, President Trump.

Catherine Rampell: Marco Rubio and Tom Price (briefly) join the resistance

The Post’s View: States can fix Republicans’ Obamacare mess

The Post’s View: Maryland’s ingenious plan to fix Obamacare

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