|
One way of looking at Donald Trump’s plan for the Affordable Care Act, which has leaked out and is expected to be announced this week, is that it’s a surrender. While stopping short of making Democratic enhanced subsidies for millions of insurance exchange customers permanent, it does extend them for two years, similar to a bipartisan outline introduced last week. And while there are changes to the subsidies, some are relatively more benign than expected.
With Trump’s endorsement, Republicans who have been resistant to maintaining anything related to the Affordable Care Act may feel pressured to do so. And Democrats may be in a position to declare victory in their long fight, punctuated by a 43-day government shutdown, to extend virtually all of the subsidies and prevent disastrous insurance premium spikes.
But there’s more to this story.
The Trump plan also includes nominal minimum payments for everyone—that is, abolishing any zero-premium plans—as a supposed anti-fraud measure. Now, there has been an epidemic of companies cheating the ACA system by signing people up for exchange coverage, or switching their existing coverage, particularly in the insurance fraud hotbed of Florida. Since most people wouldn’t notice or care if they got signed up for a free plan, the insurance broker or agent can fraudulently collect the government subsidy. The Republican idea is that adding a nominal payment would cut down on scamming. But the root of this problem is malicious companies, not the typical Republican welfare queen stereotype.
The Trump team has a bigger goal, though, of opening up the market to Health Savings Accounts and junk insurance run by middlemen. They’ve hit upon a way to provide cash incentives to make insurance potentially unusable when you actually need it. That will be lucrative to the private contractors with the power and influence to capture the market.
|
