Trump's Obamacare Crisis
Like too much else in Washington, the slow-motion collapse of Obamacare was an eminently avoidable crisis. The question, now that it is happening, is whether President Donald Trump and Congress want to work together to contain it.
With Anthem Inc.'s alarming decision to quit Ohio's health-insurance marketplace, 18 more counties can now be added to the territory where people who qualify for federal subsidies will have no insurance plans to buy next year. Trump has actively sought to destabilize the law -- by repeatedly threatening to withhold federal payments owed to health insurers, making it easier for people to dodge the tax penalty for not having insurance and, with Congress, threatening to replace the law with a system that would separate millions of Americans from health insurance.
The result of all this has been to undermine insurers' confidence in the system. Anthem cited the "increasing lack of overall predictability" of the market as part of its rationale for withdrawing from Ohio.
Congress could easily take measures to remove some of that uncertainty. One would be to appropriate the billions of dollars the law provides annually to reimburse insurers for the costs of covering low-income policyholders. Until it does, the Trump administration should make all necessary assurances that these "cost-sharing" payments will be made. Without that assurance, insurers on the exchanges will have to drastically raise premiums.
Congress should also fortify the individual mandate by raising the tax penalty for people who decide to go without health insurance. Then the Trump administration would need to ensure that the Internal Revenue Service makes every effort to enforce it.
State governors, for their part, can help stem the insurance-company exodus by following the example of New York Governor Andrew Cuomo. He has just banned insurers who leave his state's exchange from participating in Medicaid and the children's health insurance program.
At this point, unfortunately, even these steps may not be enough to bring insurers back to every marketplace by 2018. So something will also need to be done to help people in those "bare counties" where no exchange plans will be available. One option is to let those people use their subsidies to buy insurance outside the exchanges. Another is to let them shop for insurance on the District of Columbia exchange, the one members of Congress use.
Sadly, the president and Congress remain distracted by their ongoing, largely hopeless effort to pass their disastrous replacement for Obamacare. Better to set that effort aside, as some Republicans senators have suggested, and address the problem at hand. "Repeal and replace" may work as a campaign slogan, but it's not quite realistic as policy -- or even, as polls increasingly suggest, as politics.
--Editors: Mary Duenwald, Michael Newman.
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