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Trump has squandered a unique opportunity for bipartisan health reform

Under the guise of “lower costs and more options,” the president has unveiled a series of changes to the Affordable Care Act that will do anything but. These efforts will increase premiums, decrease coverage, and seriously grow the federal deficit.

Not only will these initiatives not solve any of Obamacare’s problems, but they will actually make them worse, especially on the issue of affordability.

{mosads}In a one-two punch last Thursday night, the administration first announced that it will allow so-called association health plans with limited state or federal oversight, then later declared that it will halt crucial ACA subsidies. These subsidies, also known as cost-sharing reduction subsidies, or CSRs, help American families with incomes up to about $61,500 pay for deductibles and co-pays. Over 7 million Americans currently qualify for CSRs.


These proposals follow previous administration announcements that shortened the open-enrollment period in the exchanges from 3 months to 6 weeks, reduced the advertising budget for enrollment in the exchanges by 90 percent from $100 million to $10 million, and cut back funding for navigators who help people buy insurance in the exchanges.

This is truly a “parade of horribles.” By refusing to pay for CSRs, at least 1 million Americans will be left without health insurance. Premiums in the exchanges are projected to increase by over 20 percent in 2018 because insurance companies will not be paid for the CSRs and will raise premiums for the money.

Many health insurance companies will be more likely to exit the exchanges, potentially leaving counties with no insurance companies. In 2018, despite Republican claims, there are absolutely no counties without at least one insurance company in the exchange.

This administration will also expose Americans to more health insurance fraud and scams. The history of these association plans is scandalous at best, marked by premium-paying Americans whose plans — encouraged by loose state and federal regulations — abscond with their money, leaving behind millions in unpaid health care bills. So common was this behavior that the Government Accountability Office once derided association health plans as “a source of regulatory confusion, enforcement problems, and, in some instances, fraud.”

Association health plans will also destabilize the traditional insurance marketplace by siphoning off the healthy and young, leaving the remaining enrollees with higher premiums. In the mid-1990s, a similar arrangement in Kentucky exempted AHPs from benefit and rating requirements. Following these reforms, 45 of the 47 individual market insurers withdrew, healthy Kentuckians shifted to AHPs in droves, and premiums in the traditional marketplaces spiked.

TrumpCare will fail miserably to deliver on either its promise of increased coverage or decreased costs.

To top it all off, TrumpCare will also worsen the federal deficit. By increasing premiums, the federal government, by law, will have to increase subsidies to Americans who buy insurance through the exchange. It is estimated that canceling the CSRs will cost the federal government nearly $200 billion over the next 10 years.

Under TrumpCare, a few thousand people — the younger and healthier people in the exchanges — will benefit from lower premiums in the association health plans. The rest of us will be left to suffer, whether from loss of insurance, higher premiums, or higher deficits. Health care, for the majority, will not become more affordable. There is no party this reform effort will please.

This is what we get when politicians pander to extremists instead of trying to forge proposals that actually address the real problems Americans face. It is high time we focus on issues all parties can agree on — excessively high drug costs, paying physicians and hospitals to improve quality and lower costs, and competitive bidding to lower prices for all sorts of health equipment and services. Trump has squandered a unique opportunity for bipartisan health reform by making the entire system worse.

Ezekiel J. Emanuel is chair of the department of medical ethics and health policy at the University of Pennsylvania and a senior fellow at the Center for American Progress. He was the founding chair of the department of bioethics at the National Institutes of Health. Until January 2011, he served as a Special Advisor on Health Policy to the Director of the Office of Management and Budget and National Economic Council.  Aaron Glickman is a policy research analyst at the University of Pennsylvania.  Emily Gudbranson is the senior research assistant for Dr. Ezekiel Emanuel.

Tags ACA Affordable Care Act association health plans Healthcare TrumpCare

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