Over the course of his 8 months in office, President Trump has shown an alarming lack of clarity regarding how he wants the repeal and potential replacement of the Affordable Care Act to look. At times President Trump has advocated for both a simultaneous repeal and replace package and a repeal now and replace later approach. He has called the House GOP's health care plan "incredibly well-crafted" one month and "mean" the next. And he has vowed to replace the ACA with a health care plan that aims to provide "insurance for everybody" only to push legislation that would rip health insurance away from up to 32 million Americans.
At this point, it is safe to say that President Trump cares far more about repealing the ACA than he does providing a viable replacement that would insure Americans in similar or greater numbers. This compulsion to undo arguably the most important achievement of President Obama's 8 years in The White House should come as a shock to no one, particularly if you've been paying attention to Trump's oft-threatened Plan B regarding health care: to let Obamacare fail and pass the blame on to the Democrats.
As early on as the first week of his presidency, Mr. Trump floated his desire to nudge the Affordable Care Act towards failure through neglect at the annual GOP retreat. He has doubled down on this goal as time has gone on and Congressional Republicans have failed to pass legislation. In the wake of the collapse of one of the Senate GOP's ACA replacement plans, President Trump flatly said that it was time to "let Obamacare fail," insisting that "the Republicans are not going to own it" and recommending that the GOP use the implosion of the American health care system for political gain.
Now, with time running out on the Republican Party's chances to repeal and replace the ACA through the reconciliation process, President Trump has quietly accelerated the process of destroying it from the inside. In recent weeks, the Trump administration has slashed the advertising budget for the coming open enrollment season from $100 million down to $10 million while also reducing the funding for the insurance navigator groups from $62.5 million to $36.8 million, with some navigators losing up to 90% of their funding. Add to that the fact that the Trump administration has shortened the ACA open enrollment period by half, only running it from Nov. 1 through Dec. 15 as opposed to the customary Nov. 1 through Jan. 31 timeline, and you have a recipe for confusion, chaos and, ultimately, much lower enrollment numbers.
These draconian and unwarranted funding and enrollment period cuts are just the most recent and extreme manifestations of the Trump administration's ongoing, low profile attempt to cause the ACA to implode. Earlier in the year, the Trump administration spent taxpayer money that was intended to promote ACA enrollment and used it to create YouTube videos attacking it. Similarly, President Trump has purposefully sowed uncertainty about the future of health care markets by consistently threatening to end the cost sharing reduction payments that allow low-income Americans to purchase insurance.
Should the ACA still be the law of the land come Oct. 1, the next big challenge for HIV and health care advocates will be fighting back against the Trump administration's underhanded efforts to drive down enrollment in ACA marketplaces. With only half as much time to get people enrolled and considerably less money at the disposal of navigators and federal employees charged with doing ACA outreach, it will take a concerted effort from anyone and everyone on the health care advocacy spectrum to make sure the general public is aware of their health care options and able to find a plan that works for them.
[Note from TheBody.com: This article was originally published by AIDS United on Sept. 22, 2017. We have cross-posted it with their permission.]