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Sabotage Watch: Are ACA Opponents Trying to Undercut Enrollment So There’s Less Coverage to Replace?

This is the first in a series of posts that will track policy or process changes that would sabotage the Affordable Care Act (ACA) even without President Trump and Congress repealing it. These efforts put the health security of people at risk by weakening coverage, raising premiums, and reducing insurer participation in the individual insurance market.

Recent Trump Administration actions call into question its commitment to maintaining an insurance marketplace that has sufficient numbers of healthier enrollees – which is essential for the health insurance system and should be everyone’s goal, no matter what their views of the ACA.

The Administration announced last week that it would stop planned ads for the final week of open enrollment for marketplace health coverage, which ends today. And it had planned also to stop sending reminder emails to consumers, retreating from that plan only after an outcry from health experts, advocates, and insurers.

Successful outreach, particularly in the final days of open enrollment, is key to maintaining a stable marketplace. Experience from the first three open enrollment periods shows that many consumers wait until the last minute to enroll and respond well to last-minute reminders. Last year, 790,000 people, more than 8 percent of total signups, enrolled in coverage in the last two weeks of open enrollment— 687,000 of them in the last week.

Young consumers are particularly responsive to deadline pressure, and young people are critical to the success of the marketplaces because they tend to be healthier and thus less costly to cover. Encouraging them to enroll doesn’t simply ensure that more Americans have health coverage; it also contributes to the overall health and stability of health insurance markets and thereby reduces the likelihood of premium increases and insurer pullouts. Placing such efforts in jeopardy only weakens the marketplaces.

Similarly, President Trump’s January 20 executive order instructing federal agencies to take steps to help undo the ACA could heighten concern among insurers that fewer healthier people will enroll if people believe the ACA’s individual mandate won’t be enforced. That could prompt more insurers to pull out of the marketplace as they look toward 2018.

Contrary to claims by ACA repeal proponents like President Trump and House Speaker Paul Ryan that insurance markets are in a “death spiral” – and reported efforts by Republicans to encourage insurers to say they won’t participate in the exchanges – the Administration inherited a health insurance marketplace that was enabling millions of Americans to find affordable coverage. Enrollment in the individual market has grown each year since the ACA took full effect, even in areas where premiums rose, and this year’s sign-ups have roughly matched last year’s so far.

A key question is whether the Administration will build on that progress or undermine it. Repealing the ACA would leave millions more uninsured and raise premiums significantly, even in the short term, independent analysis shows. Any alternative to the ACA will be graded on how it stacks up to the system that the new Administration inherited. Sabotaging that system in hopes of creating greater political urgency for repeal, or a lower bar for any replacement bill, is no substitute for devising an approach that actually improves Americans’ health security.

Going forward, policymakers should be judged on whether they further strengthen private insurance markets or cynically undermine them — and the people that depend on them — in a misguided rush to “repeal and replace.”