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Trump Admin Vows to Stabilize Insurance Market, Then Moves to Destabilize It

Trump has made no secret of his plan to “let Obamacare implode, then deal,” regardless of how many people get hurt along the way. Now they're slashed funding for Obamacare outreach by 90 percent.

Jesse Hicks

Nicholas Kamm/Getty Images

For months, Republicans have vocally anticipated the impending collapse of the Affordable Care Act's health insurance marketplaces. During their effort to repeal, replace, or otherwise muck with Obamacare, President Trump and congressional Republicans cited this alleged collapse to stoke urgency for a vote. That effort is seemingly now dead—or undead?—but the Trump administration continues to undermine the health markets, making them less stable while loudly proclaiming the need to stabilize them.

Its latest tactic is to slash funding for Obamacare outreach and advertising by 90 percent. The $100 million spent on advertising last year will be cut to $10 million, according to Health and Human Services officials. Advertising is crucial to reaching potential enrollees and informing them about when and how to sign up. Getting the word out is especially important for the upcoming 2018 enrollment season, which is considerably shorter than in previous years, running from November 1 to December 15. Last year, in contrast, ACA enrollment remained open from November 1 to January 31—more than twice as long.

"The surest way to kill the exchanges is to keep them a secret," Timothy Jost, a consumer advocate at the National Association of Insurance Commissioners, told Vox. "Sick people will find them, but getting younger and healthier people enrolled is the problem."

And if cutting off advertising sounds familiar to you, it's because the Trump administration pulled the same thing last year, pulling ads during the crucial final week of open enrollment. Remarkably, administration officials are now citing what they claim are diminishing returns from advertising as one reason for the cuts, pointing to a decline in enrollment last season. That decline occurred in late January—right around the time the administration stopped running ads.

"People are aware of Obamacare and the exchanges, they are aware they can sign up," an HHS official told reporters. "The Obama administration doubled spending on advertising and saw a 5 percent decline in enrollment. Despite a doubled budget, there are diminishing returns." Another unnamed official (three spokespeople took a conference call with reporters, though they declined to give their names) later admitted they'd done no studies to measure awareness or judge the efficacy of advertising.

Alongside the advertising cuts, funding for in-person enrollment will also be slashed. In 2016 the Obama administration spent $62.5 million in grants to nonprofits and health clinics that helped people sign up for coverage through the ACA. These "navigators" guided people through the nuts and bolts of enrollment, but also reached out to their communities, advertising the open enrollment period.

The Trump administration will cut that number to $36.8 million for next year, focusing its cuts on grantees who didn't meet their enrollment numbers. HHS officials told reporters the program has been ineffective, only signing up 81,426 enrollees. In one case, an HHS spokesperson said, one $200,000 grant led to only one enrollment.

Elizabeth Hagan, associate director of coverage initiatives at Families USA, told Vox that the HHS numbers don't tell the whole story. The navigators do more than simply process sign-ups; they reach out to the community, offer advice to new enrollees, and remind current enrollees to re-enroll. "They may be helping one consumer with an application but they're letting their families know, and letting their friends know," Hagan said.

The slashed budget is likely to depress enrollment significantly—which seems exactly the point. Trump, after all, has made no secret of his plan to "let Obamacare implode, then deal," regardless of how many people get hurt along the way. Members of his administration seem content to go along with the plan, while claiming they're looking out for Americans. One administration official, speaking anonymously, told the New York Times, "I think people want stability in the marketplace.," adding "We want the healthcare market, the individual marketplace to function and to function well. It is not functioning, the way it is today." That's not true, but the Trump administration is doing everything it can to make it so.

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