WASHINGTON – Republicans weren't able to repeal Obamacare, but they're doing a fine job of tearing it apart piece by piece.
The latest proof of that came last week, when the Justice Department told a federal court that it would not defend two of the Affordable Care Act's central pillars: the individual mandate that required people to have health insurance or else face a tax, as well as the requirement that insurers offer coverage to people with pre-existing conditions.
The Supreme Court upheld the individual mandate in 2012, but now a group of states is suing on other grounds to try to destroy both the requirement that people buy insurance and almost all of Obamacare. Led by Texas, those 20 states argue that the law is unconstitutional.
The Trump administration won't go that far, but the brief the Justice Department filed in the case argued that the individual mandate is indeed unconstitutional. And if it is, the Justice Department said, it's also unconstitutional to block insurers from denying coverage to those with pre-existing conditions, or to charge those people higher rates.
Now this is a court case, which means it's months or years from being resolved. But it's really just the Trump administration's latest attack on the 2010 law that aimed to deliver health care to millions more Americans.
Here are some of the other things the Republicans in Congress and the Trump administration have done to undermine a law that GOP lawmakers have tried and failed to repeal:
- Ending the individual mandate: It's really no surprise that the Trump administration won't back the individual mandate in court, given that it already backed its repeal. And while it largely went unnoticed, Republicans in Congress did indeed repeal the individual mandate – the central underlying premise of Obamacare – in their big tax cut/tax overhaul legislation last December. That means that starting next year, people won't face a tax penalty if they don't have health insurance. And according to the Congressional Budget Office, it means that about 8 million Americans will lose their health insurance in the coming years.
- Ending Obamacare subsidies: Last October, the Trump administration cut off the "cost-sharing reductions" that went to insurance providers to help underwrite coverage for lower- to middle-income people who don't get health care from their employers. Insurers anticipated the loss of those subsidies, and therefore raised the cost of "Silver" health plans under Obamacare by 7.1 percent to 38 percent in the first year after the change, and are seeking even higher rates this year.
- Pushing "junk" insurance plans: The Trump administration announced last fall that it was allowing cheaper-short term insurance plans to be sold under Obamacare, billing this as a consumer-friendly move. But even the administration acknowledges that the benefits under these plans are so skimpy that if you buy one and get sick, you may face “increased out of pocket costs, possibly leading to financial hardship.”
- Expanded "association health plans": The administration earlier this year announced plans to expand "association health plans," where small businesses or other employers can band together to offer health insurance. The move cost prompt more than 4 million people to drop their Obamacare coverage in favor of plans with a history of fraud and failure.
- Limiting open enrollment. The Trump administration cut back on advertising for last year's open enrollment period under Obamacare, and also shortened the length of time that people had to choose health plans. Obamacare enrollment subsequently fell by about 4 percent.
- Medicaid work requirements: The administration has said it is open to a huge change in the federal/state health program for low-income Americans. It's opening to requiring them to work for look for work, which could lead to the largest cut in Medicaid recipients ever. The change would be particularly important to the 33 states that expanded Medicaid under Obamacare, including New York.
Obviously, that's a lot of change, all at once, but it's too early to see exactly how all those changes will work out. But they appear to be aimed at fulfilling a prediction Trump made last July.
“I think we're probably in that position where we'll let Obamacare fail,” he said.
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Story topics: The Briefing