While unable to repeal and replace President Obama's Affordable Care Act, president Trump has done much to sabotage his predecessor's signature achievement.
After dismantling key parts of the ACA, Trump has helped significantly drive down enrollment this year. Given Obama's plan was specifically designed to reduce costs for everyone by increasing enrollment (the more people in the health care pools, the lower the premiums), Trump's actions have predictably led to higher costs for everyone. Trump has achieved this spectacular coup by:
1. Allowing people to remain longer in “skimpy” plans -- cheap, short-term plans that Obama tried to get rid of given their lack of benefits and high co-pays.
2. Getting rid of the individual mandate. The mandate was still in effect for most of 2018, but this was the first enrollment period it wasn't. And predictably, enrollment went down.
3. Slashing the budget for advertising the enrollment by a whopping 90%.
4. Cut funding for customer service reps who help people with the enrollment process.
5. Reducing the enrollment period.
Accordingly, the sign-ups have fallen by 11.7 percent as compared to last year, and the number of new people buying coverage has dropped by 19.7 percent.
While Trump is no doubt ecstatic about the negative impact he has had on Obamacare, he might be surprised to learn that the states hit hardest by the rising health care premiums are the ones that voted overwhelmingly for him. Alabama, Arizona, Nebraska, North Dakota, Texas, West Virginia, Wisconsin, and Wyoming are all seeing enormous hikes in prices this year, with only one Democratic voting state, Rhode Island, seeing similar spikes.
This means Trump's actions are disproportionately hurting Trump's voters.
In yet another attempt to smash Obamacare, the Trump administration is planning on allowing states to direct billions of dollars of ACA subsidies to Trump's "skimpy" plans that don’t meet the ACA's stringent requirements. Why? According to Trump, it is to make insurance less expensive, but of course this is simply not true.
As many analysts have pointed out, by taking people out of the ACA pools and letting the buy inadequate coverage for lower prices, it will force people with more complex health needs to pay more, or simply go without. And again, if you look at the demographic that gets hit hardest by these policies -- people in red states who are 60 years or older making between $20,000 and $40,000 a year -- a huge percentage voted for Donald Trump.
Health care is going to be one of the most important topics over the next two years, particularly given Democrats now control the House and have power to preserve what is left of the ACA. This will inevitably play into their Democrats' hands as they gear up for the 2020 election too, and Trump is giving them all the ammunition they need. Given the Democrats have been talking about making universal coverage a possibility, there is a real upside to all of this. Unfortunately though, millions of Americans are going to suffer in the meantime.