Democracy & Government

Undercutting Health Care In America

Republicans in Congress couldn't kill the Affordable Care Act, so the administration has been trying to sabotage it.

Undercutting Health Care In America

Protesters hold a small peaceful demonstration in support of health care on Sept. 23, 2017 in Livingston, Montana. The state of Montana expanded Medicaid under the Affordable Care Act. (Photo by William Campbell-Corbis via Getty Images)

Since Donald Trump became president, the Republican majorities in the House and Senate have twice failed to repeal and replace the Affordable Care Act (ACA). Consequently, Obamacare remains the law of the land. And, by law, the job of overseeing the health care exchanges falls to the Department of Health and Human Services (HHS). But now it appears HHS itself is doing its best to sabotage the process.

 
Anti-Obamacare Messaging
Last summer, The New York Times outlined three ways the department has used our tax dollars to launch a campaign against Obamacare: 1) HHS released dozens of video testimonials, all were critical of Obamacare. 2) Tom Price, the now-former head of HHS, tweeted at least 48 anti-Obamacare infographics to support efforts to repeal the bill; and 3) perhaps most obstructionist of all — the department began deleting useful information and enrollment guidance from its website as soon as Trump was inaugurated. “Here, it’s an agency trying to destroy its own program because it opposes it,” Kathleen Clark, a government ethics expert and professor of law at Washington University, told The Times, “It is inconsistent with the constitutional duty to take care that the law is faithfully executed.”

 
Thwarting Community Assistance
The Trump administration is also cutting back on its grants to contractors who train health care exchange “navigators.” The navigators are located in libraries, businesses and nonprofits to help people shop for plans. At the end of August, Kaiser Health News reported that the Centers for Medicare & Medicaid Services was cutting funding for navigators in 38 states by 40 percent, down to $36.8 million; and cutting advertising by 90 percent down to $10 million. By contrast, California budgeted $111.5 million to advertise Obamacare this year. Earlier in the summer the Associated Press reported that the administration canceled $23 million worth of contracts in 18 cities. As Elizabeth Hagan, who works for the advocacy group Families USA told the AP, “It’s not letting the law fail, it’s making the law fail.”

Navigators — if they survive the budget cuts — must complete an online certification course. A number of groups are reporting that the training software seems to have more bugs this year. “Chief among the complaints,” according to reporting from Kaiser Health News, “are repeated error messages and lost or unsaved work.” Moreover, when trainees call the Centers for Medicare & Medicaid Services, which is responsible for the training, people are noticing that they appear much less helpful than in prior years.

 
Closing the Window of Opportunity
During the first four years of the federal exchange, Healthcare.gov, the open enrollment ran for three months, from Nov. 1 through the end of January. This year the open enrollment ends on Dec. 15 — that’s less than half the time. If you thought that HHS would go out of its way to let people know there’s less time to sign up, remember the budget for advertising was cut by 90 percent. HHS is also cutting back on website hours. A shutdown will take place for 12 hours on all but one Sunday from midnight to noon ET.

Critics say that is precisely the time that many working people — a key target for the federal insurance — might shop for a plan. A Utah-based health care navigator, Jason Stevenson, told Kaiser Health News that 10 p.m. MT is a popular time locally. He foresees the shutdown making it hard to complete an application in a timely fashion. “Health insurance is complicated, and in the past couple of years we had an administration that made it easier to sign up, but that has really changed in the past six months, with more hurdles not only for consumers but for those whose job it is to help them.” But a spokesperson for Medicare & Medicaid Services, which oversees the exchanges, disagreed, saying the outages were scheduled for low-traffic time periods.

 
Parting Shot
Former Health Human Services Secretary Tom Price resigned after squandering at least $1 million in taxpayers’ dollars on his extravagant travel on private planes. But just before he stepped down, HHS regional directors were told not to participate in the open enrollment events that are held in their regions across the country according to a report by BuzzFeed News. Roy Mitchell the executive director of a health advocacy program in Mississippi told BuzzFeed that for the past four years, representatives from HHS helped him coordinate enrollment. This year HHS canceled at the last minute.

In a notice informing participants they would be canceling the events, Mitchell said HHS’ “destructive actions will ultimately reduce enrollment, increase costs and drive up the uninsured rate in Mississippi.”

“I didn’t call it sabotage,” Mitchell told BuzzFeed News. “But that’s what it is.”

The future of Obamacare still hangs in the balance. While Trump and the Republicans majority in Congress have been unable to kill the law, they are now trying to cheat consumers of reliable and informed access to the federal exchange. Whomever is chosen as the new secretary of Health and Human Services can choose to play by the rules, or not. The New York Times reports that the two of the top candidates are Scott Gottlieb, the current commissioner of the Food and Drug Administration, and Seema Verma, the current administrator of the Centers for Medicare and Medicaid Services. Choosing Verma, according to The Times, promises more of the same:

Ms. Verma, an ally of Vice President Mike Pence, worked closely this year with Republicans in Congress on their proposals to undo the law and to cut Medicaid, the program for more than 70 million low-income people.

Choosing Gottlieb, according to The Times sends a different message, that perhaps the administration wants to find ways to change:

In his first months at the FDA, he has deftly balanced the concerns of patients and pharmaceutical companies, while taking steps to combat the opioid epidemic and speed access to lower-cost generic drugs.

In the meantime, a career official, Don Wright, M.D., MPH, was appointed as Acting Secretary of Health and Human Services. He has a small window of opportunity to steady the helm, or he can continue to steer the the Affordable Care Act into the ground.

Gail Ablow

Producer

Gail Ablow is a producer for Moyers & Company and a Carnegie Visiting Media Fellow, Democracy.

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