Caretaker for Obamacare? Trump’s health care role may shift
The
"It's either caretaker or undertaker," quipped economist
Every move by Trump's health chief will be scrutinized by
The Trump administration's first sign-up season, for 2018 coverage, starts in about three months, on
Some things to watch for:
INTENSE SCRUTINY
Consumer organizations, state officials,
"We are going to hold HHS accountable to fully implement the law," said lawyer
Former Obama administration officials intimately familiar with the program will be looking over the shoulders of the Trump team — Twitter accounts at the ready.
Price so far has sent mixed signals. His department recently canceled contracts for community groups to provide sign-up assistance in 18 cities. His official rhetoric about the law has been harsh, maximizing its faults without recognizing the health benefits of 20 million more people with insurance.
But the department did work with
About 10 million people are signed up for private insurance in subsidized markets, and 11 million more have coverage through expanded Medicaid.
DON'T OVERLOOK THAT COMPUTER SYSTEM
Few things were as damaging to Obama's aura of cool competence as the failure of the HealthCare.gov computer system when it went live in the fall of 2013. Few people managed to sign up that first day, and it took weeks for a technological rescue team to sort through layers of problems, restoring acceptable functionality.
After that chastening experience, Obama administration officials constantly kept tinkering with the website, trying to improve its technical capacity and usability for consumers.
It's unclear what the Trump administration has been doing since he took office in January. No media preview of 2018 open enrollment has been announced.
The administration may have made its own job harder by cutting in half the sign-up season for next year. This time, open enrollment will run from
In earlier years,
The day falls on a Friday — a sort of "Black Friday" for health insurance sign-ups.
"The system has to be ready at the start, and they have to be prepared to detect problems, especially when they hit the end," said Antos.
UNCERTAINTY OVER SUBSIDIES
The clearest signal Trump could send of his administration's good faith would be to remove the uncertainty around billions of dollars in payments to insurers. That money reimburses the insurers for reducing copayments and deductibles for people with modest incomes.
The "cost-sharing" subsidies are called for in the health law, but they are under a legal cloud because of a lawsuit brought earlier by
After the
"If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies...will end very soon!" said one of Trump's Twitter messages.
Experts say the money is not a bailout, but a government obligation.
Without a subsidy guarantee from Trump, some insurers have been seeking double-digit premium increases, on top of raises that reflect underlying medical costs.
"This month-to-month uncertainty is just corrosive," said former HHS Secretary
LOSING GROUND?
Obama's law reduced the
That was widely seen as an indicator of progress under the health overhaul, and one of the main problems for the recent Republican bills is that they would have significantly increased the number of uninsured people.
Amid confusion about the future of the ACA, there are signs that coverage is already beginning to erode.
A major survey called the Gallup-Sharecare Well-Being Index recently estimated that the number of adults without health insurance grew by about 2 million this year.
What happens next is in the hands of the Trump administration.
Online: www.HealthCare.gov
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