What happens when a president is willing to let the health care system he is now responsible for, in his own words, ‘explode’?
Rhetoric from the Trump administration that they will “let” Affordable Care Act marketplaces fail along with lack of interest in taking measures to keep insurers in its exchanges, compounded with renewed talks by Republicans on the hill over repealing and replacing the ACA, is a perfect storm for market uncertainty and a self-fulfilling “explosion.” This was no more evident than in Donald Trump’s speech after the American Health Care Act bill was pulled from the House floor without a vote.
“I’ve been saying for the last year and a half that the best thing we could do, politically speaking, is let ObamaCare explode. It’s exploding right now.” – President Donald Trump
The reason that Republican leadership is rushing renewed talk of repeal before the Easter recess is because we’re edging closer to June 21st, the date when insurers have to both decide whether or not to stay in ACA marketplaces and finalize their 2018 plans and rates. While talk alone doesn’t determine policy, it certainly signals where it is headed.
In other words, the “American Health Care Act 2.0” as legislation is all smoke and mirrors. Debates behind closed doors and the resultant uncertainty over insurance regulations, cost-sharing programs, reinsurance payments, and level and nature of the subsidies for consumers to purchase insurance alone will push insurers out of the market and collapse certain state exchanges.
All economic indicators, including evidence from the nonpartisan Congressional Budget Office and the Brookings Institution, point to the ACA exchanges as not in a death spiral. There is no clear or immediate need for Congress to repeal and replace the law. Premiums have risen, but enrollment has remained steady and more people continue to gain coverage each year.
However, the lack of stability created by the false urgency to present and vote on rushed, shoddily-written legislation will certainly throw certain states into one and disproportionately harm states that Trump won in last November’s election.
Anthem, one of the ACA’s largest insurers and the sole option for many consumers in certain U.S. counties, is likely to pull out of many regional exchanges in 2018, leaving counties in Colorado, Kentucky, Missouri, and Ohio without any ACA insurance plans or 2018.
Similarly, Humana, which has already announced that it will not provide any plans under ACA exchanges next year, leaves many counties in Tennessee without any ACA insurance options.
The end result is that hundreds of thousands of people, primarily in rural counties, will be left without any insurance options and thus no access to affordable health care.
The future of patient care is entirely on Trump and his administration, who have, in his own words, already put politics over patients. If people lose access to care, he will have no one to blame but himself.