On a call with reporters this week, a Trump administration official who asked not to be identified refused to say exactly what the government will and won’t do to uphold and promote the Affordable Care Act during this fall’s open enrollment period.
The New York Times reported that the message conveyed in the meeting was that the Trump administration “will do the minimum necessary to comply with the law,” but no more, raising existing fears that the government’s inaction will intentionally depress insurance signups.
Here is how the unnamed official with the Department of Health and Human Services (HHS) addressed the biggest unknowns about the future of Obamacare:
Navigators
The HHS official refused to say if the government will release this year’s payments to thousands of navigators who help people sign up for health insurance. That payment of tens of millions of dollars has already been appropriated, and would normally come in early September, but the administration may still refuse to distribute the funds.
Promotion and outreach
The official refused to say whether they will do anything to promote open enrollment signups starting in November, and seemed to question the purpose of the Obama administration’s past aggressive outreach efforts, which ranged from TV ads to celebrity endorsements to partnerships with civil rights and religious groups across the country.
“I don’t think we can force people to sign up for the program,” she said.
The official then characterized some outreach and enrollment assistance programs as wasteful. “What we’re seeing with some of the programs is you’re spending a lot of money on it, but the idea of these programs is to sign people up,” she said. “And if you’re giving them a grant and they’re only signing up a few people, then we’re actually wasting money there when we’re spending thousands of dollars to sign up one person. That doesn’t make any sense.”
She also refused to say how much the administration will spend on outreach this year.
Enrollment targets
Every year since Obamacare’s marketplaces launched in 2013, the administration has set a goal of how many people they aimed to enroll. Last year, for example, they set a target of 13 million people, and were able to nearly meet it.
This year, the official said, HHS “had not set any numerical goals for sign-ups.”
CSRs
While the Trump administration made the August installment of Obamacare’s cost-sharing reduction (CSR) payments to insurers—subsidies that support the coverage of low-income people with severe health needs—the fate of future payments is anyone’s guess. The official would not say whether the administration would continue paying the CSRs subsidies, and again seemed to question their effectiveness.
“CSRs have been paid for the past three years since the program started, and what have we seen in terms of premiums?” she said. “Even though you had CSR payments, premiums have gone up over 100 percent since it started.”
The non-partisan Congressional Budget Office does not agree, and put out a report in August finding that ending the payments would drive premiums up by as much as 25 percent by 2020 and would lead to 5 percent of the U.S. population having no access at all to a non-group insurer.
