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WASHINGTON — As the Trump White House administers blow after blow to the Affordable Care Act, congressional Democrats are planning to take steps on their own to try to prevent or delay the demise of individual marketplaces where 12 million Americans buy insurance.
With the crucial open-enrollment period for Obamacare markets just three weeks away, President Trump announced his intention to strip insurance companies of billions in funding that will likely spike premiums and could cause insurers to flee the markets. Meanwhile, his administration has slashed funding for enrollment outreach. Both moves are likely to significantly depress enrollment in exchanges.
“We have to take matters into our own hands as to having to be navigators ourselves, to say to people, ‘This is the time to sign up,’” Democratic Minority Leader Nancy Pelosi, D-Calif., said Thursday. “The bigger the pool, the healthier the pool, the lower the cost.”
Democratic senators and congressmen are planning events, social media campaigns and media interviews to urge their constituents to enroll, attempting to make up for the steep cuts in advertising the Trump administration has made. Pelosi’s office is distributing a tool kit to Democratic House members with ideas to help them boost enrollment in their districts. They fear that the lack of outreach from the White House will mean younger, healthier people won’t sign up for insurance, resulting in an older, sicker pool and higher premiums for everybody.
“Sick people will figure it out and get there the first day,” said Rep. Bobby Scott, D-Va., who is working with health care and other groups in his district to enroll people. “The people who would be persuaded by advertising are those who think they may or may not need it.”
The open-enrollment period begins Nov. 1 and goes through Dec. 15.
Democrats say the president is “sabotaging” the Obamacare individual markets as a result of his party in Congress failing to repeal the law. The Trump administration is slashing the advertising budget for open enrollment by 90 percent (from $100 million to $10 million), as well as cutting funding for groups that help people sign up, called “navigators,” by 40 percent, according to a Kaiser Family Foundation report. The administration also announced that the website where people can buy insurance, healthcare.gov, will be down for maintenance on several Sundays during open enrollment.
On Thursday night, the Trump administration announced it would no longer reimburse insurance companies with cost-sharing reduction payments, which the Congressional Budget Office predicted would increase the deficit by $194 billion over 10 years while hiking premiums 20 percent in 2018 alone. Insurance companies could also decide to pull out of the marketplaces altogether.
All this uncertainty will likely depress enrollment.
“People are going to be very confused; it’s a short open-enrollment period,” said Tim Jost, a health care expert and professor emeritus at the Washington and Lee University School of Law. “This is an elaborate sabotage campaign.”
Democratic lawmakers have asked the Health and Human Services (HHS) inspector general to investigate the agency’s decision to slash advertising, a tactic that appears to have depressed Obamacare enrollment last January. They’ve also asked the Government Accountability Office to look into HHS’s using its social media channels to promote Obamacare repeal. (The office launched its investigation in July.) Sen. Patty Murray, D-Wash., the ranking member of the Senate committee that oversees health care, is working on a deal with Sen. Lamar Alexander, R-Tenn., to restore the cost-sharing payments to insurers, which would help stabilize the markets.
But until — and if — those tactics bear fruit, the Democrats’ best hope for propping up the exchanges is getting the word out that they still exist.
“You have to clearly alert people to the idea that the sign-up period is imminent, and if we can’t depend upon the advocacy that the Obama administration put in place, then you’re going to have to resort to other opportunities,” said Rep. Richard Neal, D-Mass.
Trump has insisted that if insurers pull out of the marketplaces and they collapse, the American people will blame former President Barack Obama, not him.
“Obamacare is Obama’s fault. It’s never going to be our fault,” Trump said in an interview with Forbes published earlier this week. “I mean, the insurance companies are fleeing and have fled. They fled before I got here. But with that being said, no, Obamacare is Obama’s fault. It’s nobody else’s fault.”
Democrats vehemently disagree, pointing to the Congressional Budget Office’s analysis that the marketplaces were stabilizing, except for uncertainty about whether the Trump administration would continue the cost-sharing reduction payments.
“There’s a difference between the Affordable Care Act dying and somebody killing it,” Scott said.
Even some Republicans are skeptical of Trump’s claims that voters won’t blame them, given they control Congress and the White House. Rep. Charlie Dent, R-Pa., who is not seeking reelection in 2018, said on CNN that he believes Republicans will “own” premium increases that are likely to come from the president’s decision.
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