The Future of Health Care Belongs to President Trump and Republicans in Congress
President Trump and Republicans in Congress frequently assert that their efforts to repeal or undermine the Affordable Care Act (ACA) are necessary because the health insurance market is in a “death spiral.”
This is a false claim.
The individual health insurance market is not collapsing
In fact, multiple independent analyses show that the market is far from collapsing. It is on a path toward stability and profitability – and will remain on this path if Congress and the Trump Administration stay the course and drop their efforts to undermine the law.
In other words: The primary threat to the stability of the market and the future of the ACA lies in decisions made by President Trump and the Republicans in Congress.
Independent analyses show the health insurance market is on a path toward stability
Republican claims that the market is collapsing couldn’t be further from the truth. Independent industry analysts have consistently reaffirmed that the core of the ACA – the individual market– continues to stabilize and improve:
- CBO predicts stability: The nonpartisan Congressional Budget Office (CBO) has stated that the market is on track to be stable in future years under current law.
- Standards and Poor’s declares market is on path toward greater stability and profitability: S&P Global Ratings recently assessed that the market showed strong signs of improvement in 2016 and is on a path toward greater stability and profitability in 2017. S&P explicitly stated that the market is “not in a death spiral.”
These assessments show that given the time and support needed to mature, true of any new market, individuals and insurers can have confidence in the market going forward.
President Trump and Republicans in Congress could easily reverse progress toward stability
Importantly, S&P also noted that these gains could easily be reversed if the Trump Administration and Congress stray from “business as usual.” Unfortunately, nothing about the administration’s actions in its first months in office indicate that they are committed to building on the progress of the ACA, much less business as usual.
To the contrary, the Trump Administration and Congress are insistent on continuing to undermine, if not outright repeal, the ACA and they now have the tools at their disposal to do so.
The timing is critical: Insurers are deciding right now whether or not to participate in the individual market in 2018. A number of key decisions by the administration in the coming weeks could mean the difference between a path toward increasing market stability or heightened market problems. Examples include:
- Funding for cost-sharing reduction (CSR) subsidies: The Trump Administration and Congress must act immediately to fund cost-sharing reduction (CSR) subsidies, which make health insurance affordable for low-income consumers. Without clear action to show that funding will continue for these subsidies, many plans will choose not to participate the individual market in 2018, effectively spelling the collapse of the market.
- Enforcement of the individual mandate: In response to the Trump Administration’s executive order on the ACA, the IRS announced earlier this year that it would not step up planned enforcement of the law’s individual mandate. While not a change in current policy, this action has the potential to inject instability into the market as insurers can no longer be confident that the administration remains committed to enforcement of the mandate, which is critical to maintaining the balanced risk pool necessary for a stable market.
- Repeal, or scaling back, of the Medicaid expansion: Republicans have long been opposed to the ACA’s expansion of Medicaid. Recent ACA repeal efforts and administrative actions have attempted to eliminate or undermine coverage under this provision. Repeal of the Medicaid expansion could have significant consequences for the stability of the market in states that have elected to expand. Data have shown that in these states the expansion has had a positive impact on the health of their market, including lower premiums for individuals in the marketplace.
- Actions to deter enrollment in marketplace coverage: Robust enrollment numbers, particularly by younger and healthier individuals, are key to a balanced risk pool and long-term market stability. Yet the Trump Administration has taken a number of actions that run counter to this goal. During the end of the most recent open enrollment the administration pulled ads designed to help encourage people to enroll in coverage and it recently changed marketplace rules, making it significantly harder for people to enroll.
- Uncertainty in Congress about the future of the law: The constant threat of repeal from Congressional Republicans remains a significant source of potential instability. Despite initial defeat, Republican leaders are not giving up pushing their bill to repeal the ACA, the American Health Care Act, and the president continues to publicly push for repeal. Markets require clear rules for all participants in order to function efficiently and effectively. Without an understanding of the rules of the road, insurers can’t be confident that it’s in their interest to participate.
People in America hold the Trump administration and Congress responsible for future of health care
What happens next with the ACA belongs to President Trump and Congressional Republicans – for better or worse. They inherited a market that is on a strong path toward stability – one that has provided coverage for millions of previously uninsured individuals – and their decisions alone will chart the course for its future. Perhaps President Trump will listen to the two-thirds of people in America who say they want the administration to do what it can to make the law work. And if the administration doesn’t, take note: More than 60 percent of people in America say they hold this administration and Congress responsible for what the future holds.
View our new ACA Attack Tracker for updates on Trump Administration sabotage attempts.