On Wednesday, the Trump administration refused to say if it would "promote enrollment this fall under the Affordable Care Act or pay for the activities of counselors who help people sign up for coverage." Donald Trump and his team, an official told the New York Times, are only willing to do "the minimum necessary to comply with the law."
What does that mean in a practical sense? As TPM reported, the answer came into focus yesterday, when Trump's Department of Health and Human Services announced plans to gut its budget for promoting enrollment and helping American consumers sign up for coverage.
Last year, the officials said, the Obama administration spend about $100 million on educating Americans about their health insurance choices and urging them to enroll. This year, HHS will spend just $10 million.Additionally, HHS will severely cut back funding for hundreds of navigator groups across the country who provide in-person assistance to people signing up for health insurance, making the grants conditional on how many people each group signed up last year.
To justify the move, a senior HHS official told reporters, "People are generally aware of Obamacare and the exchanges. They are aware of the products out there and aware they can sign up."
In other words, as far as Donald Trump's administration is concerned, marketing and publicity just aren't important when promoting a product. That's consistent with the president's record and worldview, right?
All joking aside, there is no credible way to spin Trump World's spiteful tactics on this: it seems pretty obvious that the president and his team are taking these steps to sabotage the health care system for brazenly political reasons.
And that's not just cruel; it's also foolishly counterproductive.
Everything HHS said yesterday pointed to a deliberate campaign to undermine the Affordable Care Act. The deadline for enrollment, for example, has been moved up -- something many consumers may not know and are less likely to hear about because the administration doesn't intend to make much of an effort to tell them. We also learned yesterday that the promotional money Trump's HHS will spend will focus on online ads, text messages, and emails -- but nothing on television or billboards, which reach a broader number of people.
The substantive effects of such an approach matter. We know that people who are most in need of care are likely to sign up for coverage, with or without a meaningful public-relations campaign, because their health vulnerabilities require them to pay close attention. But for the system to work well, insurers need plenty of healthy people to get insured, too.
In other words, by slashing the promotional campaign, the system is more likely to end up with a more expensive pool of patients, which forces premiums higher, costs taxpayers more, and creates more volatile markets.
Taken together, there's every reason to believe the Trump administration is taking deliberate steps to make the American health care system worse, so that the president and his allies can run around saying, "See? Obamacare doesn't work." Instead of focusing on helping people, the emphasis is on creating partisan talking points.
As of yesterday, they aren't even being especially subtle about it, and an untold number of families will be forced to deal with real-world consequences.
For those who care about reality, when a system that's working well starts getting worse, Donald Trump will own this fiasco, lock, stock, and barrel.