Cut #2- ending risk corridor payments
The effort to repeal and replace the ACA has failed... at least for now. President Trump has said that we should “let Obamacare explode” and then “we'll end up with a truly great healthcare bill in the future, after this mess known as Obamacare explodes.”
The problem is that the ACA has no intention of complying. With the failure of TrumpCare, more states are considering expanding Medicaid. Actuaries and other experts have said that the ACA is NOT in a death spiral- it’s not dead yet.
Rather than waiting for the ACA to implode on its own- something that might never happen- the Trump Administration and Republicans are likely to help it along; apply a cudgel to the old noggin, so to speak.
They can’t take down the ACA in an obvious way, lest they pay a hefty political price for doing so. Instead, they will probably use the technique of lingchi, or “Death by a Thousand Cuts,” to do the job.
None of the “cuts” in and of themselves is likely to prove fatal to the ACA. But the cuts will accumulate and add to each other, until, finally, the ACA does indeed die. If they apply these cuts over a sufficient time period, the 24-hour news cycle might not be able to connect the dots. In this way, Trump and the Republicans will murder the ACA without having blood on their hands… well, not much blood anyway.
It is our job to point out each and every drop of blood so if the ACA does die, the American public knows who the murderer is.
Three cuts have already been applied so far.
Cut #1 was inflicted by the Roberts Court, which allowed states to opt out of Medicaid expansion. Republican controlled states that did not expand Medicaid did not see the expected big decrease in uncompensated care. Ultimately, this translated into higher premiums for all.
Cut #2 was inflicted by Republican Congress when it eliminated “risk corridors,” which were designed to stabilize the exchange markets at the start up of ACA. Insurers weren’t sure of how sick or healthy exchange enrollees would be. Risk corridors would shift profits from insurance plans that over-estimated how sick enrollees would be to insurance plans that under-estimated how sick enrollees would be. If the exchanges OVERALL under-estimated the health of enrollees, the federal government would compensate the insurance companies from the General Fund. This mechanism was to be in place for several years as the insurance companies gained experience with the new exchange markets.
Conservatives called this a bailout. Republicans, lead by Marco Rubio, got risk corridors removed from the ACA by inserting a “poison pill” amendment into a must-pass budget bill. Loss of the stabilizing effect of risk corridors has led to insurers leaving the exchanges and jacking up premiums.
Cut #3 was inflicted by Trump when he killed advertisements for the ACA and promised to repeal it. This probably led to a drop in enrollment compared to the previous year.
It is likely that future attacks will be made by Secretary of HHS Tom Price using administrative rules to inflict the cuts. He might also decline to defend the ACA enrollee subsidies in a current court case.
More “poison pill” amendments in upcoming must-pass budget bills are also possible. Do you see a pattern here? If Republicans can get a few Democrats voting for the bill they can frame the Democratic Party for the murder of the ACA.
Watch this space for future inflicted cuts.
