Questions Roil Over First ACA Enrollment Period Under Trump

It appears that the Trump administration would prefer to cripple the Affordable Care Act (ACA) rather than administer a law it hates.

After President Trump’s best efforts to repeal the ACA failed last month, his administration cancelled contracts with two companies that helped thousands of Americans in 18 cities find health care, adding to the uncertainty over how the ACA enrollment period will proceed. The enrollment period also has been slashed to just 45 days, starting Nov. 1 and ending Dec. 15.

These actions are the administration’s latest effort to muddle how citizens can access Obamacare. After Trump took office in January, his administration cancelled ads — many of which had already been paid for — designed to remind the public of the last days of the sign-up period for the ACA insurance market. The administration’s new suspension of contracts ends enrollment fairs and insurance sign-ups in public libraries, offering one of the few signs of how it plans to handle the upcoming ACA enrollment period.

The Washington Post reports:

With that sign-up period less than three months away, the government appears to be operating on contradictory tracks, according to insurers, state insurance commissioners, health-policy experts and leaders of grass-roots groups that have worked to enroll the roughly 10 million consumers around the country who now have ACA coverage.

President Trump continues to stage photo ops at the White House and on travels with people he terms “Obamacare victims.” The Department of Health and Human Services is issuing weekly maps showing the few dozen counties that might lack an ACA health plan for next year. And despite the failure of Senate Republicans to abolish much of the law, Trump and his top aides have not entirely relinquished hopes of a victory in Congress this fall.

During the congressional health care battle, the Department of Health and Human Services (HHS), now under Secretary Tom Price, produced videos that depicted the ACA as harmful to doctors and families — even though the health department is, by law, supposed to administer the services of the ACA. However, The Washington Post also reports that the HHS wing that oversees the insurance marketplaces and the HealthCare.gov website has been operating as usual, holding its annual meeting in June with representatives who help steer customers toward ACA health plans.

Though it is difficult to tell the difference between problems with the ACA caused by the administration’s hatred of the law from those caused by its incompetence, how the administration proceeds from here is crucial. The Washington Post explains: “While the GOP’s recent legislative pyrotechnics have attracted the greatest attention regarding the law’s future, the most practical test of the Trump administration’s intent is whether it will help or hinder the marketplaces, designed for people who cannot get affordable health benefits through a job.” Virtually all the questions asked about whether HHS is planning for the open enrollment period are answered with uncertainty:

It’s entirely opaque to us,” said Julie McPeak, Tennessee’s insurance commissioner and the incoming president of the National Association of Insurance Commissioners. She said that she and colleagues have contacted officials at HHS, the Justice Department, the White House’s intergovernmental affairs office, and its Office of Management and Budget, trying to learn which part of the government would make the decision about these cost-sharing payments and when.

“And we can’t get a clear picture,” McPeak said. As a result, she noted, Tennessee cannot plan its own outreach efforts because it is impossible to provide consumers accurate information about insurance prices and choices for the coming year.

Even HHS employees are unclear about what they are allowed to say about the enrollment period. According to the Post:

Federal health officials declined Thursday to answer questions about a half-dozen specific facets of the impending enrollment season. Instead, a spokeswoman for HHS’s Centers for Medicare and Medicaid Services issued a generic statement: “As open enrollment approaches we are evaluating how to best serve the American people who access coverage on HealthCare.gov.”

An hour later, the spokeswoman, Jane Norris, requested that the statement be withdrawn, saying that she did not have permission to release it. Asked again for detailed answers, neither she nor anyone else at HHS responded further.

The remaining questions include whether the president will follow through on his stated resolve to end payments made to insurers on behalf of 7 million low-income customers to help them afford the ACA plans’ deductibles and copays. Without those subsidies, policy premiums likely will spike in 2018. Additionally, it is unknown whether the government plans to notify ACA customers of the shortened enrollment period or how automatic enrollment will be handled.