Statewide: In the aftermath of the implosion of the Affordable Care Act replacement plan late Friday afternoon, the biggest immediate threat to affordable health coverage may be deliberate sabotage by the Trump Administration, Congress, and states like Wisconsin where conservative politicians are bitterly opposed to the health care law. With the legislative vehicle for radical restructuring the American health care system closed for the time being, State Innovations Waivers with states like Wisconsin may become the new method for achieving the goals of repeal.
After House Speaker Paul Ryan pulled his replacement bill on Friday President Donald Trump said: “I’ve been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode. . . . It is exploding now.” But the Congressional Budget Office and independent researchers conclude that the Affordable Care Act (ACA) as currently constituted will be stable for years to come. This assumes that the Trump Administration does not use its substantial administrative power to undermine the health care law.
The willingness of conservative politicians to play politics with the health coverage of the American people has been in evidence since the original passage of the ACA. As Citizen Action of Wisconsin has continuously documented, the Walker Administration has sought to sabotage the ACA by encouraging healthy people to buy substandard policies outside of the market; refusing to enact robust rate review; turning down Medicaid expansion; hamstringing health care navigators, rubber stamping health insurance industry mega mergers, and seeking waivers that would allow insurance companies to take larger profits. Taken together the Walker Administration has aided and abetted the on-going effort of the national for-profit insurance companies to continue to insure healthy people and find ways to avoid people with pre-existing health conditions.
The conservative majority in Congress has also played a major role in sabotaging the ACA. For example, they dramatically cut risk adjustment payments to insurance companies who insure more people with health conditions. This hit insurers that were doing the right thing with huge unexpected costs, driving many out of the the ACA marketplace and many new health care Co-ops out of business.
Before the failure of the latest legislative attack on the ACA last week, there were already indications of an intent to sabotage the health care law by not enforcing the individual mandate, pulling public promotion in the final weeks of open enrollment, not defending against a Congressional lawsuit that could pull tax subsidies from moderate income Americans, allowing substandard health insurance policies to be sold, and by cooperating with with states like Wisconsin that want to undermine the law. Trump’s selection of the vehemently ideological Tom Price as Health and Human Services Secretary is also evidence of an intent to disrupt the ACA. Major media outlets such as the New York Times, Washington Post, and Politico are now reporting that the Trump Administration may double down on sabotaging the health care law.
If the Trump Administration adopts sabotage as the next front in it’s attack on the Affordable Care Act, the biggest opportunity for radically changing the health care law may be State Innovation Waivers which under the ACA can be negotiated starting this year. These waivers permit states to submit plans to dramatically restructure health coverage. The Walker Administration would be an ideal partner for Secretary Price to develop a State Innovation Waiver which undermined the purpose of the ACA.
“With conservatives in charge of the government they have a solemn moral obligation to uphold the laws of the land and to protect the welfare of the American people. It is stunning that conservative politicians are so bent on getting their way that they are willing to play politics with the lives of their own constituents by throwing sand into the gears of the American health care system,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “The right of every American to have quality affordable health coverage ought not to be a partisan issue. Now that the American people have resoundingly rejected their disastrous replacement plan, it is time for conservatives to take on the responsibility of actually governing by working with Democrats to move beyond the divisive health care battle and improving and building on the Affordable Care Act.”