Obamacare enrollment is shrinking after Trump’s sabotage

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The Trump administration set the law up to fail.

President Trump hasn’t succeeded in repealing Obamacare yet. But his administration is doing its best to force the law to fail.

The most critical time of the year for the health care law is open enrollment, when millions of people log on to online marketplaces, check whether they qualify for federal subsidies to help them pay their premiums, and shop for plans. For the past three years, at least 10 million people have gotten insurance that way each year.

Open enrollment is almost over: It ends Friday, December 15, in most states. So far, sign-ups have been somewhat strong in the face of the Trump administration’s overt sabotage. As of Dec. 9, 4.7 million people had signed up for insurance on the federal marketplace.

But they still seem likely to fall short of previous years. We can expect about 1.6 million to be automatically enrolled in a new plan at the end of open enrollment, if they haven’t actively selected a new one, based on the last two years. It would require an almost-unfathomable surge in the last week for 2018 enrollment on HealthCare.gov to match the 9.2 million in 2017. Something closer to 7.5 million or 8 million is looking more plausible.

"We expect enrollment to grow every year, not to shrink. This market is likely to shrink," Caroline Pearson, senior vice president at Avalere, a consulting firm, told me last week. "It is a big deal, for a market that's already too small and unstable."

The difference is Trump. This year, open enrollment was in the hands of a White House that’s openly hostile to the Affordable Care Act — and the Trump administration took advantage of the best opportunity it had to undercut the law.

President Trump has said Obamacare is imploding, which he hopes would reignite the stalled congressional effort to repeal it. He didn’t just sit around waiting for that to happen. His administration halved the length of open enrollment. They slashed spending on advertising and assistance programs. They pulled out of outreach events at the last minute.

The entire health care law could be at stake. Advertising and outreach are primarily targeted to younger and healthier people, who are essential to the law’s goal of affordable insurance coverage for all Americans. If their enrollment drops while older, sicker people keep signing up, premiums are going to increase even more next year.

It could be the start of a death spiral, a self-perpetuating cycle of price hikes and falling enrollment — which is exactly what Trump seems to want.

“I think what this cumulative activity can do is start that death spiral,” Kathleen Sebelius, President Obama’s health and human services secretary during the ACA’s first open enrollment, told me.

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https://www.vox.com/policy-and-politics/2017/10/11/16447504/obamacare-open-enrollment-trump-sabotage