Halfway through his four-year term, President Trump hasn’t able to deliver on a campaign promise to get rid of Obamacare. Instead, the administration said Friday, the White House has found a way to make it work for everyone.
The White House Council of Economic Advisers reported last week that three of Mr. Trump’s biggest changes to the law — changes Democrats call “sabotage” — will result in $450 billion in net economic benefits over the next 10 years.
The benefits flow to consumers, who will find cheaper options and won’t be fined for shirking insurance they don’t want, and to taxpayers, who won’t have to subsidize people who never wanted Obamacare plans in the first place, according to the council’s analysis.
The changes will also slash administrative costs tied to the Affordable Care Act’s regulations, the council said.
The council, which advises the president, acknowledged tradeoffs in Mr. Trump’s push to gut Obamacare’s penalty for shirking insurance and expand the reach of cheaper, skimpier alternatives to the law’s offerings.
Some higher earners, who don’t qualify for taxpayer-funded subsidies under Obamacare, will face higher premiums, as healthy people opt out of the exchanges and into Mr. Trump’s workarounds, the report said.
The council said that’s a small price to pay for easing the pain for millions of people who under the old system had been subsidizing the costs of sicker customers.
“The benefits of giving some consumers more insurance coverage options outweigh the costs imposed on those consumers who are projected to pay higher premiums,” the report said.
It’s a shift from the early days of the Trump White House when it said the health law was on the brink of collapse and that a GOP-controlled Congress would sweep in with a better plan. Republican efforts failed, forcing Mr. Trump to figure out what he could do on his own.
He let consumers hold onto “short-term” plans, which don’t have to comply with protections for sicker Americans, for a full year. The move restored an Obama-era standard that lasted until 2016, when the last president shortened their maximum duration to three months.
And Mr. Trump expanded the reach of association health plans that let people in like-minded trades band together to improve their purchasing power. The plans don’t have to cover the complete menu of benefits demanded by Obamacare.
Mr. Trump boasts most frequently about his push to zero out Obamacare’s “individual mandate” penalty in the GOP tax overhaul. Republicans said it tended to punish families making less than $50,000 and wasn’t very effective in prodding healthy people into the program.
“The penalty and other restrictions on consumer choice are not needed to support the guaranteed issue of community-rated health insurance to all consumers, including those with preexisting conditions,” the report said. “The ACA premium subsidies stabilize the exchanges.”
That argument is at odds with a state-driven lawsuit that seeks to invalidate Obamacare. GOP state attorneys general say because the mandate and the law’s goodies were supposed to in tandem, the law is no longer constitutional.
The Trump administration has taken a hands-off approach to the lawsuit, enraging Democrats who say the Justice Department has an obligation to defend federal law.
Obamacare’s defenders rejected the council’s findings Friday, saying it attempted to paper over Mr. Trump’s damage to the program after Democrats retook the House by running on health care.
“The Trump administration’s relentless sabotage of our health care system is well-documented,” said Brad Woodhouse, executive director for Protect Our Care. “In November, voters took to the polls and rejected the Republican war on health care, and the fact that this administration is launching a massive cover-up of their sabotage means that they’re already bracing themselves against the wrath of voters in 2020.”
The White House council said it simply took a more holistic approach than past studies, which focused on sign-ups in President Obama’s program instead of its impact on all populations.
The report assumes Mr. Trump’s changes will remain in place over a 10-year window, despite the simmering lawsuit and political winds that constantly swirl around the 2010 law.
On Wednesday, Democrats will begin vetting bills that seek to roll back some of Mr. Trump’s changes.
One measure before the Energy and Commerce Committee would rescind Mr. Trump’s decision to let consumers hold onto the short-term plans for longer.
Another bill would restore outreach and marketing funding for HealthCare.gov — the main Obamacare website — that Mr. Trump slashed after taking office. Democrats have blamed the lack of outreach for dips in year-to-year sign-ups.
A third measure by Rep. Ann M. Kuster would force the administration to rescind guidance that allows states to use Obamacare waivers, or “1332s,” to repackage federal Obamacare money in broad ways. Democrats are worried that states will use the money to subsidize the bare-bones plans promoted by Mr. Trump.
The individual mandate, meanwhile, remains a political football.
A federal judge in Texas said Congress’ decision to zero out the penalty in its tax overhaul should invalidate the rest of the law, citing Chief Justice John G. Roberts Jr.’s interpretation of the law’s mechanics in 2012. Blue-state attorneys general are appealing the decision.
Some legal experts say the fight could likely go away through legislative changes, such as setting the mandate at a low amount or passing a law that wipes the mandate from the books completely.
Yet so far, House Democrats have pressured the administration to change course and oppose the lawsuit, or support legislation that affirms Obamacare’s protections for people with preexisting conditions.
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