Former Secretary of Health and Human Services Tom Price resigned on Friday after being caught in a scandal in which he took expensive chartered flights without justification.
His short and ignominious tenure at the department was characterized by leading the Trump administration’s fight of the Affordable Care Act, and involved tactics that many observers saw as sabotage to the 2010 health care law known as Obamacare.
One of his final moves to hinder the ACA is the HHS’s shuttering of the federal health insurance exchange HealthCare.gov every Sunday for 12 hours during the open enrollment period, which goes from Nov. 1 to Dec. 15.
The Department said the site will be down for maintenance from 12 a.m. to 12 p.m., preventing people from sorting out their 2018 coverage Sunday mornings, according to a tweet from Kaiser Health News’ Phil Galewitz.
Since inauguration, the Trump administration has taken steps to stymie the success of the ACA, despite the law surviving numerous attempts at several repeals. President Donald Trump campaigned on a platform of its repeal, and while in office has repeatedly incorrectly asserted that it “isn’t failing, it’s failed — done” and wished for its demise.
Obamacare has not died on its own, however. While the problems of high costs are far from fixed — Congress has not attempted to fix it yet — the market is stable, and previously uninsured counties have managed to find insurers for 2018. Now, every county in the U.S. has an option.
‘Planned HealthCare.gov downtime during open enrollment’
The open enrollment period is when most people buy health insurance for the year, as you can typically only buy outside of that period if you have a qualifying life event like a job change or a marriage. All but 15 states use HealthCare.gov to publicly offer individual health insurance plans. In addition to the 12-hour overnight shutdown for six weeks, Kaiser Health News also reported the site will be down on Nov. 1, the first day of open enrollment.
“Why not do it before? Why not do it after,” said Abbe Gluck, a Yale University law professor specializing in politics and health law. “My own suspicion is that it’s a technical matter they can justify as an administrative matter. It seems thinly veiled especially when placed alongside the many other instances of intentional sabotage to make it more difficult for people to enroll.”
Narrowing the window will likely decrease enrollment, as it reduces the time a person has to sign up for a plan. “Anyone who has been through limited enrollment knows the amount of time you have facilitates your ability to get it done,” Gluck said.
With each Trump move, the message has gotten louder. Lori Lodes, who previously ran ACA outreach, told Yahoo Finance, “the kindest word you could say is that it’s sabotage.”
A spokesperson for the HHS did not respond to comments by publication time.
The enrollment period has already been cut in half
This isn’t the first time the Trump administration has narrowed the time period for open enrollment, a move that restricts sign-ups and drives costs for insurers up, something that hurts the market. (Industry groups frequently note that they do better when more people are involved.) In September, the enrollment period for this year was revealed to be cut in half to six weeks from 12. Previously, open enrollment used to run through the end of January, giving families a little more time to get their plans in order.
Former CEO of HealthCare.gov told Bloomberg earlier this year that a huge number of people sign up right at the deadline, and a deadline shift may catch people off guard.
The Trump administration has crippled ACA advertising
The damage from a shorter open-enrollment period was magnified by the Trump administration’s suppression of advertising for the program. In January, between the inauguration and the end of open enrollment, the Trump administration pulled $5 million in Obamacare advertising, at the time citing it was searching for “efficiencies.”
In late August, the Trump administration dealt an even bigger blow by slashing the HHS budget for ACA advertising during open enrollment by one-tenth, to a mere $10 million from $100 million in 2017. With a shorter window and fewer announcements, the Trump administration is following a recipe designed to decrease enrollment.
“The ad thing is a really big deal,” said Gluck. “You can’t overestimate how important the cutback on the pre-enrollment period ad events are. It’s a deliberate attempt to weaken the law with disappointing enrollment numbers.”
In late September, HHS also told its directors in its 10 regions not to participate in enrollment events. Andy Slavitt, former head of Medicare and Medicaid Services for HHS, said not investing in these partnerships will reduce enrollment, drive up costs and the rate of Americans who are uninsured, according to Talking Points Memo.
Foot dragging despite promises of fostering “innovative thinking”
In March, Price announced that he would make state waivers easier to get, to give the localities flexibility in finding health care coverage that fit their unique regions.
On Friday, however, Oklahoma withdrew a request for a waiver for a reinsurance program. In a strongly worded letter to Treasury Secretary Steven Mnuchin and Price, the state criticized the unexplained delays in the approval process. The withdrawal was necessary, the letter said, to provide a clear picture of 2018 for insurers. “It’s a pretty solid rebuke from a Republican state to a Republican president,” Gluck said.
The letter concluded: “[The] lack of timely waiver approval will prevent thousands of Oklahomans from realizing the benefits of significantly lower insurance premiums in 2018.”
The administration has sowed uncertainty over cost-sharing reduction payments
Trump and his administration has significantly equivocated over whether they will follow through with payments to insurers to compensate for individual plans for lower-income consumers. These payments, called “cost-sharing reduction payments” or CSRs, are such a big deal that the Congressional Budget Office calculated that premiums would spike 20% if Trump suspended them.
However, some damage has already been done. Earlier this year, Dr. Mario Malino, former CEO of Molina Healthcare, told Yahoo Finance that the uncertainty has already driven up premiums, as insurers must hedge if they think there’s a chance they won’t get reimbursed for the discounts they offer certain individuals. “This is causing a lot of destabilization in the marketplace,” he said at the time.
What Trump could do to help instead of hurt health care
Trump seems to be dead set on an Obamacare failure, but there are a few ways he could help the market, if he chooses to. The first would be to guarantee that his administration would continue CSRs, which would reassure insurance companies, stabilize the marketplace, and keep premiums from rising even higher.
The administration could also make sure to enforce the ACA mandate and its penalty for noncompliance, something that it tried to loosen with an executive order earlier this year. The Internal Revenue Service, however, indicated it would still impose the mandate penalties. In addition to giving penalties, providing positive reminders through advertising would similarly help the market, though this is unlikely, given the slew of recent measures.
However, the administration’s efforts, will depend largely on who succeeds Price. The acting Secretary of HHS, Don J. Wright, has been a careerist and milder in comparison to Price. The two leading candidates to take over may be Seema Verma, Vice President Mike Pence-allied administrator of Centers for Medicare and Medicaid Services, and the milder Scott Gottlieb, head of the Food and Drug Administration. Neither seems likely to generate bipartisan support.