Is The Trump Administration Trying To Sabotage Obamacare?

by Jon Hecht

On Friday afternoon, Sen. John McCain announced that he will not vote for the Graham-Cassidy health care bill, the latest, and perhaps last, attempt by Republicans to repeal and replace Obamacare. With the GOP only having a two-vote margin of error in the Senate, and Sens. Rand Paul and Susan Collins already having expressed serious reservations about supporting the bill, the bill is probably dead. Rather than ending the Affordable Care Act, the Trump administration will have no choice but to keep implementing it as the law requires. But the proper functioning of the law seems like it will hit some snags, since the Obamacare website will be down for maintenance during open enrollment.

The Trump administration had already cut down the time period for open enrollment from the 90 days it had been in 2016 to just 45 days. And now, it turns out that for almost every Sunday of that period, the health care website would be undergoing maintenance from 12 a.m. to 12 p.m., according to a webinar the Department of Health and Human Services did with marketplace assisters. According to Vox health care reporter Sarah Kliff, Obama administration health officials call this kind of outage "abnormal," and say it didn't happen in previous years.

The announcement that would be down on Sunday mornings comes after the Trump administration already announced a pretty massive cut to outreach programs, slashing 90 percent of the budget for ads, as well as cuts to in-person navigators who help people sign up for the program.

The outreach budget and enabling people to properly use the website matter a lot. Health insurance depends on a stable risk pool, where there is a balance of healthy and sick people who have bought insurance, meaning that when people get sick, they are subsidized by the healthier people paying premiums at the same time.

The fear is that as long as outreach isn't coming out, people won't sign up as much, and since people who are more likely to be sick or have pre-existing conditions are the ones who will likely sign up no matter what, while healthy people may not be as inclined to sign up, this could lead to higher premiums in the health insurance markets.

President Trump frequently expressed a desire to "let Obamacare implode" in order to push Democrats to the negotiating table to repeal the health law. And some fans of the Affordable Care Act accuse him of doing just that, pushing up premiums in order to make people unhappy with the law (even as polls have shown increased support for the ACA since Trump took office).

Already, the Congressional Budget Office has estimated that uncertainty about the fate of the law will likely lead to a 15 percent spike in health care premiums, as questions of whether the law would be repealed, or if the Trump administration would cut off Cost Sharing Reduction payments to insurance companies, lead to difficulties in business decision-making by insurers.

But the president's strategy of perhaps trying to sabotage the health care system to make it work less well doesn't seem like it will work for him politically. For one thing, it looks like Obamacare repeal really is dead (again), so the pressure of an embattled health care system the president hopes for will be all for naught. But beyond that, a poll from the Kaiser Family Foundation in April found that voters would blame Republicans if Obamacare fails.

If Trump really is trying to make Obamacare function less well, it's a strange strategy. For one thing, people's health premiums going up doesn't seem to be a reason that they would support a bill that would cut off subsidies they pay for health premiums. But with Trump seemingly unable to do anything about the problem his administration is seemingly making worse, it becomes hard to argue that his administration would be better for people's health care concerns than a Democratic one. All that he would do is just raise people's health care costs, and when people are unhappy about their economic well-being, they'll probably end up voting against the president.