Trump’s ‘artificial repeal’ could hurt 175,000 Illinoisans

Bill Knight column for Monday, Tuesday or Wednesday, Oct. 23, 24 or 25

The numbers are in, and they have the faces of our neighbors.

Government estimates of Illinoisans who could be affected by President Trump’s many efforts to dismantle the Affordable Care Act (ACA – “Obamacare”) say that 175,000 Illinoisans benefit from government subsidies Trump ordered stopped, so the equivalent of Springfield and suburban Des Plaines may face paying more or losing coverage if cost-sharing payments are killed.

Despite Congress’ unwillingness to repeal the law, Trump is unraveling health care for Americans by

withholding payments that Congress promised to pay when the ACA was passed. That undermines the legislative branch and exposes his malicious manipulations, revealing Trump’s obsession with President Obama and his key reform.

All year, Trump has enacted schemes to sabotage the law – an artificial repeal. The Top 10 are: dropping guidance for ACA consumers from the HHS website in January; weakening enforcement of the “individual mandate” (February); issuing press releases with negative information about the ACA (also February); lowering tax credits for insurance premiums (April); uploading graphics on Twitter critical of the ACA (June); posting YouTube videos critical of the law (July); cutting 40 percent of funding for groups helping people enroll and trimming $10 million from funds to promote the ACA (August); closing the ACA web site for Sunday enrollments (September); stopping HHS officials from attending open-enrollment affairs (September); suggesting cheaper, inferior plans for “associations” (October); and ending subsidies for insurers  that assist low-income consumers pay out-of-pocket medica lcosts (both October)

Although many Illinoisans get health coverage through employers or government programs like Medicare and Medicaid, hundreds of thousands are in exchange plans. In 11 downstate counties, more than 5,600 of us would be hurt, according to the U.S. Department of Health and Human Services (HHS), which calculated the ACA enrollees who are subsidized: Fulton (329 people), Henderson (95), Henry (626), Knox (493), Livingston (361), McDonough (290), Mercer (232), Peoria (1,536), Tazewell (1,160), Warren (151) and Woodford (388).

Illinois and 17 other state Attorneys General on Oct. 13 filed suit in federal court to block the action. They seek a temporary restraining order, preliminary injunction and a permanent injunction to prevent the halt in required payments.

“Ripping health-care coverage away from millions of people who need it most is not just illegal but unjust,” said Illinois Attorney General Lisa Madigan.

The ACA expanded private insurance to millions of people by creating marketplaces (exchanges) where people buy policies, and some use government subsidies to offset costs. It also required that those plans had benefits such as hospitalization, maternity care and mental-health services, and may not exclude  people with pre-existing medical conditions.

ACA helps make health coverage more affordable by underwriting part of the monthly costs of coverage obtained through Healthcare.gov and also by reimbursing insurers for limiting out-of-pocket and deductible costs.

Trump’s “association” order would let groups with common interests, like trade groups, professionals or small businesses, negotiate policies, but insurers could sell coverage without certain benefits mandated by the ACA. Such “junk” policies could offer inferior coverage and neglect people with pre-existing conditions.

Worse is his order to renege on required payments

The nonpartisan Congressional Budget Office reported that it will cause premiums to rise, insurers to withdraw from participation and increase deficits because government will still owe other subsidies for policies that would be more expensive.

Insurers may be forced to raise premiums up to 20 percent, or to drop out of exchanges.

“It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class,” said U.S. Sen. Chuck Schumer (D-N.Y.) and U.S. Rep. Nancy Pelosi (D-Calif.) in a joint statement. “Presideint Trump has apparently decided to punish the American people for his inability to improve our health-care system.”

Some Republicans object, too. U.S. Sen. Susan Collins (R-Maine) said, “We cannot simply wipe out he Affordable Care Act without having a workable, better alternative.”

Apart from politicians, critics include doctors, nurses, hospital administrators, state insurance regulators, patients and their families. American Cancer Society lobbyist Chris Hansen said Trump’s order “could leave millions of cancer patients and survivors unable to access meaningful coverage.”

Half the country favors a single-payer system, according to a survey by Politico/Morning Consult, and the  Kaiser Family Foundation reports that by a margin of more than 2-to-1, Americans support improving the ACA, not repealing or replacing it.

With luck – and Americans expressing their outrage – attempts to undermine the ACA could spark bipartisan attempts to improve the ACA, such as the plan drafted by U.S. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), or truly consider Medicare For All.