Trump Administration Still Sabotaging Affordable Care Act, Sebelius Says

Aug 17, 2017

President Donald Trump and Republican congressional leaders came up short in their initial efforts to repeal the Affordable Care Act, but former Health and Human Services Secretary Kathleen Sebelius says they’re still working to engineer its failure.

In a recent interview, Sebelius, who spearheaded implementation of the ACA, said she knows that the law isn’t perfect. But she said it would be working better if Republicans would stop undermining it.

“The notion that this law is imploding is just not accurate,” Sebelius said.

She cited Congress’ refusal to help insurance companies offset the cost of covering people with pre-existing conditions as an example. The law called for such payments to balance a requirement that insurers stop denying coverage to people with health problems.

“Congress actually took that money away,” Sebelius said. “The first year of funding was in the original bill. Congress blocked the additional funding.”

Asked if she would go so far as to say that Republicans in Congress and the Trump administration were actively sabotaging the law, Sebelius said: “Oh, there’s no question.”

“There are a lot of uncertainties about the marketplace, and that in and of itself can really undermine the law.” — Kathleen Sebelius

“Ironically, the Republican Congress did not repeal and replace, but the administration led by Tom Price at HHS — who is a vociferous opponent of the Affordable Care Act — has a lot of tools to really cut off the legs of the law,” she said.

Sebelius led HHS as a member of the Obama administration from 2009 to 2014 after six years as Kansas governor and eight years as Kansas insurance commissioner. She recently moved to Lawrence and continues to work as a health policy consultant.

During his first month in office, Trump instructed the Internal Revenue Service to back off enforcement of the individual mandate, the part of the law that requires virtually all Americans to have health insurance or pay a penalty. 

The Trump administration also cut funding for advertising to educate consumers on when and how to purchase coverage. 

“That probably dampened this year’s enrollment by about a million and a half people,” Sebelius said.

Heading into the open enrollment period for 2018, Sebelius said the most immediate threat to the stability of the marketplace is Trump’s often-stated intention to stop reimbursing insurance companies for billions of dollars in payments the law requires them to make to consumers to lower copayments, deductibles and other out-of-pocket costs. 

Policyholders who earn less than 250 percent of the federal poverty level — about $30,000 for an individual and $61,500 for a family of four — qualify for the “cost-sharing subsidies.”

“There are a lot of uncertainties about the marketplace, and that in and of itself can really undermine the law,” Sebelius said.

Some large insurers, including Aetna and Humana, have already said they will not participate in the health exchange market in 2018 due to the uncertainty. Blue Cross and Blue Shield of Kansas City has also pulled out

“What a number of the companies have said is, ‘If we don’t know if we’re going to get paid back, one of two things will happen,’” Sebelius said. “‘We will either drop entirely out of the marketplace because we cannot afford to take that kind of hit. Or we will raise our premiums substantially to cover that cost that we must by law offer to consumers.’ Either way, that’s a very disastrous thing for health consumers.”

Ending the cost-sharing subsidies would increase premiums for marketplace plans by about 20 percent in 2018, according to a recent analysis by the nonpartisan Congressional Budget Office

Read the CBO analysis on the effects of ending cost-sharing subsidies.

Sebelius said she is encouraged that some members of Congress are attempting to craft a bipartisan plan to fix the ACA in an effort to stabilize the marketplace. But with enrollment for 2018 set to begin Nov. 1, they don’t have a lot of time. 

“I’m worried that the calendar is really an enemy right now.”

The easiest solution, Sebelius said, would be for Congress to simply stop sabotaging the law and require the administration to do the same.

“They could immediately say, ‘We want the law to work the way it is,’” she said. “‘This is the law, let’s enforce the law.’”

Jim McLean is managing director of the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. You can reach him on Twitter @jmcleanks. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.