Trump can still wreck health care

In his very first executive order, directing federal agencies to “waive, defer, grant exemptions from, or delay” various parts of the Affordable Care Act, President Donald Trump stated his intention to repeal the law. Two months later, with that effort in shambles, the order has become the administration’s entire game plan on health care.
That’s not only inadequate, but reckless. With no Republican replacement for the ACA on the horizon, every step taken to weaken the individual insurance market and Medicaid risks destabilizing a health-care system in need of reinforcement.
The Health and Human Services Department wasted no time following Trump’s order. In January, it withdrew $5 million in advertising to remind people that the deadline for purchasing 2017 health-insurance plans on the individual market was at hand. If the department is as reluctant to publicize the sign-up period next fall, the number of insured Americans stands to fall.
The Internal Revenue Service, for its part, responded to the executive order by abandoning its plan to reject tax returns from filers who failed to indicate whether they had health insurance, as required by the law’s individual mandate. This, too, discourages people from buying insurance, especially healthy people who are needed to balance the risk pools and keep premiums reasonable.
The Justice Department could be next to cause trouble, by ending the government’s defense against a congressional lawsuit that aims to stop some $7 billion in federal “cost-sharing” payments to insurers, payments that enable them to reduce customers’ out-of-pocket costs. Withdrawing this support would discourage insurers from continuing to participate in the individual market.
And of course there is more mischief Health and Human Services can make. Secretary Tom Price has indicated he’s willing to let states impose a job requirement on Medicaid recipients — an idea that, if it could be enforced, would cause many people to lose or fail to qualify for insurance. Price could also narrow the so-called essential health benefits that the ACA requires policies to provide, including coverage for birth control and mental health care. And he could greatly expand exemptions to the individual mandate.
To be sure, this executive power has legal limits. The ACA was passed, as the Supreme Court has noted, “to improve health insurance markets, not to destroy them.” And the president is sworn to faithfully execute the law.
Fortunately, the existing system is not on the verge of collapse. Indeed, it stands to become more stable as the mix of participating insurance companies shifts. But there are still too many people without insurance, and in many states too few affordable choices. The president’s responsibility is to strengthen the system — not push it toward failure, or sit back and wait for it to “explode” in the hope that voters will blame someone else.
There are signs Trump may be interested in working with Democrats on the problem. If true, that would be a welcome change in approach. Lasting improvements to the U.S. health-insurance system will depend on both parties offering their most constructive ideas.

—Bloomberg