Obamacare signups ahead of last year; repealing ACA getting more problematic

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The government says that more than a million people selected plans on the federal exchange during the first two weeks of open enrollment under the Affordable Care Act, indicating sign-ups so far haven’t been hurt by President-elect Donald Trump’s plan to repeal or amend the health law.

A million+ people selected #healthinsurance plans in first 2 weeks of enrollment under #Obamacare Click To Tweet

According to The Wall Street Journal, about 53,000 more people selected plans during the first 12 days of open enrollment than during the comparable period last year, officials with the Centers for Medicare and Medicaid Services (CMS)said on Wednesday (November 16, 2016). Open enrollment began Nov. 1 and runs through Jan. 31, into the first days of the Trump administration.

Also during those first 12 days of open enrollment, 250,000 new consumers and more than 750,000 consumers renewed plans, CMS officials said. Most people need to sign up by Dec. 15 for coverage that starts Jan. 1.

“The American people are demonstrating how much they continue to want and need the coverage the marketplace offers,” Health and Human Services Secretary Sylvia Mathews Burwell said.

Mr. Trump’s victory has cast uncertainty over the future of the 2010 health law, which has reduced the uninsured rate in the US, changed insurance coverage and led more than 30 states to expand eligibility for Medicaid. The president-elect and Republicans have said they would strike down some or all of the ACA, which has been dogged by criticism over rising premiums and a drop in insurer participation.

Thousands of people calling the federal exchange call center are asking how the election will affect their coverage, said Andy Slavitt, acting administrator of CMS. He said his agency has had dozens of conversation with insurance companies eager to continue coverage. He said he was buoyed by the fact that enrollment has been climbing each day.

Mr. Slavitt also said that CMS, which oversees the health law, is committed to a smooth transfer to the new administration but has yet to hear from the Trump transition team.

“They’ve not reached out to us,” Slavitt said. He added that “we are heartened from what we hear from Republicans and Democrats that they don’t want anything disruptive,” he said.

Health analysts are watching the current open-enrollment season closely because a robust number of sign-ups would make it more politically difficult for Republicans to make changes that take away coverage from millions of Americans. Lukewarm enrollment, however, would likely reinforce GOP claims that the law isn’t working as intended and needs to be repealed and replaced.

Supporters of the law echoed Ms. Burwell. Anne Filipic, the head of the Enroll America sign-up coalition, said Wednesday that robust sign-ups in what had been a “complicated” outreach effort this year showed how many people were benefiting from the law and would need to be considered by Republicans if the law is ditched.

“There’s strong evidence consumers are actually moving now to make sure they are enrolled,” Filipic said.

Key components of the ACA could be struck down quickly if lawmakers wanted to use a budget process that allows them to get around procedural hurdles that require 60 votes in the Senate, but it may take longer to craft a replacement plan.

Mr. Trump has said he is interested in retaining aspects of the health law, such as the ability of consumers to get coverage even if they have a pre-existing health condition. Trump, along with leading Republican lawmakers, said there is a need for some sort of transition period for people who have gotten coverage under the law.

The Obama administration has said it expects to have 13.8 million people select a plan by the end of open enrollment, a bump of 1.1 million compared with the end of 2016 enrollment. The majority of people who obtain coverage on the federal and state exchanges get subsidies that help offset the costs of their premiums.

Steve’s Take:

Despite all the presidential election’s fact-free rhetoric on both sides, more than a million people selected plans on the federal exchange during the first two weeks of open enrollment under the Affordable Care Act, indicating sign-ups so far haven’t been hurt by President-elect Donald Trump’s plan to repeal or amend the health law. That’s a lot of conviction from those enrollees who don’t expect to be kicked to the curb by the Trump administration’s threat.

For months I’ve been saying the same market forces that dogged Medicare in its early stages are now at work in a serious way in shaping Obamacare to solve–fairly quickly–the issue of higher insurer premiums–pretty much the only remaining obstacle to the program working like it was intended to.

With ACA enrollment now approaching 14 million, the program is closing in on Medicare’s 17 million insured, most of whom are reasonably satisfied with their coverage.

So what’s there to fix if insurers just happened to misprice their participation in the ACA exchanges at its outset? All that’s been needed to solve the risk pool problem is to strengthen the mandate for participation (via a higher fine) and increase the subsidies for those needing assistance with the cost of their insurance.

I know, it’s not going to be quite that easy, what with the promise Mr. Trump made to repeal the ACA. I suppose he could repeal it in its entirety, but then essentially replace it with all of the coverage and cost attributes that are now making participation attractive to both enrollees and insurers. Heck, I don’t care if the “replacement” program is called Trumpcare.

Already there are tensions between Trump, who’s been wobbly on the specifics of the 2010 healthcare law and says he wants to keep the popular parts, and congressional leaders like House Speaker Paul Ryan and conservative think tanks who ideologically oppose anything associated with the Affordable Care Act.

“They’re going to get squeezed in a political vise,” says Albert R. Hunt, a Bloomberg columnist writing a piece for the Chicago Tribune.

He’s dead on.

The Republican base demands that the Affordable Care Act be repealed, but most voters have more subtle ideas. Polls consistently show that while a plurality of voters disapproves of the law, big majorities want to keep some provisions and care more about issues like rising drug prices.

While candidate Trump vowed to repeal the law, he also said he’d like to see Medicare negotiate lower drug prices and bring in cheaper drugs from Canada, positions fiercely opposed by most congressional Republicans and the drug industry.

The president-elect now says he wants to keep important elements of Obamacare, including a ban on insurance companies discriminating against people with preexisting medical conditions and another allowing children to stay on their parents’ plans until age 26.

There’s a reason Republicans have voted to repeal Obamacare dozens of times but have not, in 6 1/2 years, devised a coherent replacement: It’s an ultra-massive undertaking substantively, and perilous politically.

An example of self-deception, pointed out by Mr. Hunt: Two conservative analysts wrote in Politico last week that an exit poll showed that 47% of voters think the act went too far and only 18% thought it about right.

“That gives Republicans a mandate to pass legislation to repeal and replace the law as soon as possible next year,” wrote the analysts, Brian Blase of the Mercatus Center at George Mason University and Paul Winfree of the Heritage Foundation.

What they forgot to cite is that 31% of respondents to the same survey thought the law “did not go far enough.” The conservative replacement plans do not envision going further. Even the part on preexisting conditions would be weakened.

Mr. Hunt predicts that, a year or two from now, the headlines won’t be about rising premiums or not being able to keep one’s own physician. They’d be about some of the 20 million newly insured people being thrown off the rolls, Medicaid cutbacks for poorer Americans, crowded emergency rooms, weakening of provisions that are reducing hospital-caused patient harms, maybe some hospitals going under, and the insurance industry in bedlam.

If Mr. Ryan gets his way there could also be articles about steps toward privatizing Medicare despite Trump’s campaign pledge not to. (The speaker was called out for falsely claiming last week that this course was needed because Obamacare is causing Medicare to go “broke.” In reality, the full solvency of the hospital part of Medicare has been extended for up to 12 years.)

That particular picture would not sit well with many of the working-class voters who backed Trump. It would be one of the many lessons inflicted upon the new president.

A very serious reason to be wary of Mr. Trump’s prospects for success is the demands of the office. No problem comes to the president unless it is diabolically complicated. The Economist points out that, to date, Mr. Trump has shown little if any evidence that he has the mastery of detail or sustained concentration that the Oval Office demands. He could delegate (as Reagan so deftly did), but his campaign depended primarily on his family and a group of marginal, political oddballs.

Trump has thrived on the idea that his experience in business will make him a master negotiator. If the deal falls through, there’s always another golf course to build or resort to buy. By contrast, when the rice pudding hits the fan–and eventually it will in many different arenas—-there won’t be anyone to turn to.

I hope Mr. Trump proves my doubts baseless as far as his competency to govern goes. The danger with popular anger, however, is that disillusion with Mr. Trump will only add to the discontent that elevated him to the White House in the first place.

Steve's Take: Will #Trumpcare trump #Obamacare by the next #election in 2018? Click To Tweet

Soon, and I mean very soon, Mr. Trump is going to start feeling the heat like he’s never felt it before. I wish him well, and we will see whether Trumpcare trumps Obamacare by 2018–when the next Congressional elections occur–and then in 2020, when he’s due to run again.