Trump Hobbles Obamacare

by: J. K. Schmid Special to the AFRO
/ (AP Photo/Evan Vucci) /
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President Donald Trump pronounced ObamaCare, or the Affordable Care Act (ACA), as “dead” at a White House cabinet meeting Oct. 13.

“It’s gone,” the president said with arms crossed before the cameras documenting his announcement. “It’s no longer….You shouldn’t even mention it. It’s gone. There’s is no such thing as ObamaCare any more.”

President Donald Trump speaks to the 2017 Value Voters Summit, Friday, Oct. 13, 2017, in Washington. Trump’s decision to end a provision of the Affordable Care Act that has benefited an estimated 6 million Americans helps fulfill a campaign promise, but it also risks harming some of the very people who helped him win the presidency. Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies live in states Trump won last November, according to an analysis by The Associated Press. (AP Photo/Evan Vucci)



A same day executive order eliminated a set of subsidies, or cost-sharing reductions (CSRs), to health insurance providers that allowed them to reduce copays and premiums for working families struggling to afford health insurance. The Americans that qualify are above the poverty line and do not qualify for Medicaid.

“I cut off the gravy train,” Trump said of withholding the funds.

On Oct. 17, Sens. Patty Murray, a Democrat of Washington, and Lamar Alexander, a Republican of Tennessee, announced a tentative bipartisan arrangement to fund these subsidies for two years. No bill has been signed into law at the time of this report , and given that Congress has not passed a budget since 2015, any measure will likely be part of another continuing resolution.

Part of the president’s alleged rationale was to find a healthcare solution “where premiums don’t have to double and triple every year like they’ve been doing under ObamaCare,” he said during the same meeting.

However, premiums have only risen 12 to 15 percent this year, said Dylan H. Roby, associate professor of health services administration at the University of Maryland, College Park. And, he added, the majority of that increase is due to uncertainty in insurance markets fueled by the Trump administration’s threats.

“The Trump administration has been deciding on a monthly basis whether to cancel the payments and that uncertainty led to premium increases overall,” Roby told the AFRO. ”If we see premiums go up by 25 percent this year, half of it’s due to uncertainty, part of it’s due to the cost sharing reductions going away and then a small percentage, probably 6 or 7 percent is actually due to increases in health care costs and the risks that people in the individual market are using services.”

Further, he said, while some consumers might be driven off their health insurance due to rising costs, those that remain insured will be entitled to increased tax credits from the supposedly “dead” ObamaCare.

Cutting CSRs “actually spends a lot more federal money than would have been spent on the payments themselves,” Roby said.

If the Alexander-Murray deal does not go through, the new arrangement stands the greatest chance of injuring a large number of Black Americans but also Trump’s political base.

“Trump is really good at dog whistle politics and policy: doing things that may not have any meat underneath them,” said Judy Lubin, a sociologist, policy analyst and adjunct professor at Howard University. She described the executive order as an act of “spite.”

“This is an example where it does have substantial impact on people’s lives,” Lubin told the AFRO. “It’s just a really bad policy. Almost 50 percent of people who are eligible for these subsidies live in the South. Another 20-plus percent live in the West. We’re looking at Trump supporters: 50 percent of them are White, non-Hispanic living in these red states.”

Questions remain over the sheer complexity of ACA as it was and how consumers can protect themselves even if the tentative deal goes through. Roby was confident that savvy consumers would be able to avoid the worst impact in the exchanges, but Stephen B. Thomas, director, Maryland Center for Health Equity, wondered how his grandmother would keep up.

“She could not navigate her way through it without her hand being held,” Thomas told the AFRO. “We have far too many people in our country — especially racial and ethnic minorities, especially people living in rural areas, Black, White, especially people who live in poverty — who have no hand to hold, and so they’re left to fend for themselves.”

While immediate damage from the executive order has been avoided or at least delayed, another conversation about the future of ACA is a short two years away.

“Do we have people being rolled out of the hospital into the street? No,” said Thomas. “But the mere fact that that’s a possibility, that people could die from lack of access to care that would save their lives and, more importantly, preventative services that could actually prevent disease from occurring in the first place is the most tragic aspect of the situation that we currently find ourselves in.”

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