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What Obamacare Sabotage? Under Trump, the Health Law Is Working Better Than Ever.

Premiums are down and choice is up after Republican tweaks to the Affordable Care Act.

MIKE THEILER/UPI/NewscomMIKE THEILER/UPI/NewscomIt is becoming more and more difficult to make the case that the Trump administration "sabotaged" Obamacare. Although Democrats have repeatedly lobbed the charge at the Trump administration in response to a number of changes made to the health care law, the evidence increasingly suggests that Obamacare is working just fine. In some ways, it is working better than ever. And in the process, it is foreshadowing the health care debates of the future, and the rut that the politics of health care appears to be stuck in.

After years of double digit rate hikes, premiums have actually gone down, dropping about 2 percent for the most expensive plans, and about 1 percent for more typical plans, compared with last year. In more than 50 percent of counties that rely on the federally run marketplace to facilitate the law, premiums have dropped by an average of 10 percent. In part this is because of the law's subsidy structure, which increases the amount of federal subsidies if premiums rise, limiting the amount that beneficiaries have to pay.

Insurance companies, meanwhile, are offering plans in markets they had previously abandoned, like Tennessee. Last year, there was just one insurer operating in 78 of Tennessee's 95 counties, according to Kaiser Health News. This year, 49 counties have more than one, and some have as many as four.

All of this is happening during the first year that the law's individual mandate penalty, which imposed a tax on individuals who did not carry qualifying health coverage, has been zeroed out. And it follows the Trump administration's decision last year to end the payment of subsidies that were called for in the text of the law but not authorized by Congress, as well as the announcement of new rules allowing the sale of cheaper, less regulated plans.

It's true that enrollment is down this year compared with the same point last year, but this year's enrollment pattern may have diverged from last year's. As a Vox report notes, health insurers exiting the market last year caused many enrollees to get notices saying they had to find a new one. In addition, improvements to the economy may mean that more people are covered through their jobs. Sign-ups tend to spike near the end of the enrollment period.

It is possible, even plausible, that the Trump administration, which endorsed last year's repeal effort in Congress, meant to undermine Obamacare. But whether intentionally or inadvertently, the Trump administration's changes do not appear to have caused the law to collapse, or anything close to it. Instead, plans are cheaper and there are more choices.

So it's not much of a surprise that the law has become more popular. Nor is it a surprise that Republicans, who campaigned on repeal throughout the Obama administration, have largely abandoned their plans to wipe the law from the books. After the midterm election, which flipped majority control of the House from Republicans to Democrats, Senate Majority Leader Mitch McConnell (R–Ky.) admitted as much, saying he hoped to fix problems with the Affordable Care Act "on a bipartisan basis." Speaker of the House Paul Ryan (R–Wis.), in many ways the the GOP's chief advocate of repeal, is leaving Congress.

Since the passage of Obamacare, Republicans have not had much of a health policy endgame beyond repeal; "replace" was always a politically convenient mirage. Where the GOP will go on health care has been something of an open question.

But two years into the Trump administration, you can see the outlines of health care politics to come. Democrats, sensing an at-long-last victory on Obamacare and momentum on single-payer, will push to further expand the role of government in health care and coverage. Obamacare will stay on the books, with periodic tweaks. And Republicans—who, after all, helped conceive of the law's structure as a response to the Clinton plan in the 1990s—will come to defend, or at least accept, its existence, just as they have with Medicare.

Which means America will be stuck with the same flawed and fragmented system it has had for decades, and an all-too-familiar debate between one party that mostly wants to hold that system in place and another that wants to expand it. Republicans didn't sabotage Obamacare, but they have all but destroyed any small hope of large-scale reforms to our health care system.

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  • Jerryskids||

    Republicans didn't sabotage Obamacare, but they have all but destroyed any small hope of large-scale reforms to our health care system.

    So sort of a good news, bad news sort of thing where the bad news is that the good news is bad news and the good news is that the bad news isn't as bad as it will be soon. We ran over your mother but don't worry, she's not dead, she's just in an irreversible vegetative coma. She'll live another 30 years!

  • Daniel||

    ".....the evidence increasingly suggests that Obamacare is working just fine"

    Bullshit.

    Just because it is better now than designed, my premiums and deductible are still way above what they were before the law. Don't try to make Obamacare sound like a good thing.

  • BigT||

    You mean that 1% reduction in rate didn't compensate for the previous 50% increase?

    Suderman should write for Huffpo where they'll believe his bs.

  • CatoTheChipper||

    In my case, ObamaCare costs about 300% more than I had been paying before the PPACA. The only difference in coverage is that wife and I get free birth control meds and my 60-year-old wife could get coverage if she were pregnant. Wife and I paid about $21,000 for high-deductible ObamaCare this year with $14,000 of deductible. However, thanks to Trump's allowing one-year, renewable "temporary" insurance and elimination of the penaltax, we'll be able to get the same coverage for about $5000 next year. I never liked Trump, but he did right by me on this one.

  • Cry more||

    We can always count on you for the stupidest progsucking answer possible.

    Do your masters at least give you a reacharound after they use you, you pathetic fucking tool.

  • Cry more||

    Nah, you're just a sad fucking liar.

    You lie about paying bets.

    You lie about using sockpuppets.

    And you like about being a fuckboy for your prog masters.

    And then you cry when people remind you that you're a liar.

  • KevinP||

    Correct. My premiums went from $2,400 per year in 2012 to $9,650 for 2019.

  • Pastor Arthur M. Kirkland||

    Criticism of Obamacare is yet another dog whistle employed by the unevolved, uneducated rubes who comprise the Republican Party, as well as their siblings in the modern libertarian movement. It is their generation's version of the N-word. Rather than apply that hideous slur to our nation's most libertarian leader, they chose to repackage it in the form of a seemingly benign difference of opinion on policy. But in reality, their objections to the ACA actually reveal their hidden agenda: their commitment to bigotry, their longing for the prejudice of the past, their disdain for progress, their rejection of science, their love of cruelty, their fondness for discrimination, their subservience to white interests, their disgust towards communities of color, their opposition to reform, their hostility towards education, their yen for religious fundamentalism, their fetish for violence, their contempt for the indigent, their fear of progress, and their numbness to inequality.

  • Eddy||

    This guy is better than the real Rev.

  • Cynical Asshole||

    At first I thought it was the Rev until I double checked the name. Well done, whoever he is.

  • Rev. Arthur L. Kirkland||

    I live in a neighborhood crawling with physicians. Nearly all of them expect universal health care to arrive during the short to medium term. The huge medical conglomerates for which they work are preparing for it already, believing they already understand how to position themselves for that context.

    If Republicans wish to avoid a single-payer system, they likely need to develop a better idea without delay. So far, however, there is nothing to see (let alone anything of merit) coming from conservatives along this line. Why not?

  • Cry more||

    "I live in a neighborhood crawling with physicians."

    It's nice that they volunteer for you homeless types like that fake Reverend.

  • Red Tony||

    I gotta say, the Pastor is better than the Reverend. Unless we're talking about A7X.

  • Red Rocks White Privilege||

    He certainly has a far more extensive vocabulary than Arthur the self-loathing hicklib.

  • Rev. Arthur L. Kirkland||

    You get to call me silly names.

    I get to win the culture war, and watch you be forced to comply with my preferences throughout your disaffected, downscale life.

    I am content.

  • CatoTheChipper||

    This is what the progressive movement is all about: the will to power, to force others to comply with the preferences of an elite comprised of the sort of troll who would style himself after an androgynous anime character.

  • Rev. Arthur L. Kirkland||

    You get to complain, but you will obey. Have fun bending to my preferences, clinger.

  • Furzeydown||

    More S&M fetish.

  • LiborCon||

    "their love of cruelty… their fetish for violence"

    Sticks And Stones May Break My Bones But Whips And Chains Excite Me So Throw Me Down, Tie Me Up, Show Me That You Like Me!

  • I can't even||

    So things are working as they are supposed to.

    Democrats pass a monstrous, invasive, ruinously expensive unconstitutional program with no hopes of making the thing work.

    Republicans run on repealing it, then proceed to reform the clusterfuck into a semi-workable expansion of the welfare state that we'll have with us forever.

  • Enjoy Every Sandwich||

    Oh, don't worry. We won't have it with us forever. I'm sure before long they'll find some way to move us all the way into socialized government-run medicine which is even worse. We'll be thinking fondly on the days when we had to pay ten dollars for an aspirin, because at least there was aspirin to be had even if you weren't a member of the Politburo.

  • Pastor Arthur M. Kirkland||

    Wrong.

    Democrats passed a thoughtful, compassionate, revolutionary, affordable, pragmatic, and constitutionally sound program to help the disadvantaged.

    Republicans ran on substituting it with a racist, sexist, homophobic, transphobic, classist, and bigoted piece of legislation that is unconstitutional, unsustainable, and neo-fascistic.

    With Pelosi poised to reclaim the speakership, the carnage should subside, although the conservative venom being spewed against her is unbelievable. Obviously, it has NOTHING to do with her being a feminist woman, right?

  • Rev. Arthur L. Kirkland||

    Republicans haven't had an idea, let alone a sound one, on health care for a generation. Democrats will control the field. Conservatives will, as is customary, mutter bitterly about it from the sidelines.

  • Cry more||

    "Republicans haven't had an idea, let alone a sound one, on health care for a generation. "

    This is why progs keep losing, they are satisfied that just having a new idea, no matter how stupid, is always the right way to go.

  • Rev. Arthur L. Kirkland||

    Too dumb to recognize which side has won the culture war?

    Was it backwater religious education?

    Homeschooling with substandard parents?

    Or just disaffected, empty defiance?

  • Troglodyte Rex||

    Doubly wrong, shit stain. The Democrats rushed through a framework, not an actual thought out plan. Remember Pelosi's dumbass comment about having to pass the bill to find out what's in it?

  • Rev. Arthur L. Kirkland||

    Open wide, Toglodyte. Single-payer is coming, and you are powerless to prevent or even, mostly, to influence it.

  • Cry more||

    Trump getting elected says wha?

  • Rev. Arthur L. Kirkland||

    Trump getting elected says last, inconsequential gasp of our society's losers. Trump won't influence the timing of universal health care by so much as a year.

  • python33||

    You get to call me silly names. Bla bla bla bla bla.......

  • BigT||

    Are you forgetting Gorsuch and Kavanaugh?

    Given an appropriate case, goodbye Ocare.

  • Juice||

    4300? That's a lot.

    4,300 VA Employees Fired, Demoted, or Suspended for Negligence Under Trump

    Some 4,300 Veterans Affairs (VA) workers have been demoted, fired, or suspended since President Donald Trump took office, Vice President Mike Pence told a room of veterans caregivers on Nov. 26.

    Pence said that proves the president has "taken decisive action to restore accountability to the VA," a statement that drew loud applause and cheers from the audience.

    Data from the VA shows that some 2,058 employees were removed, demoted, or suspended in 2017, the majority of whom—1,484—were removed. In 2018, through the end of August, some 2,299 were removed, demoted or suspended, of which the majority—2,148—were removed.
  • Pastor Arthur M. Kirkland||

    Putin's targeting our nation's veterans? What a shock.

    Of course, most of these vets voted for the bastard. Perhaps if they starve to death, we'll see a renaissance of compassion, reform, progress, science, reason, education, enlightenment, love, and democracy.

  • loveconstitution1789||

    Veterans love Trump!

    MAGA!

  • Dillinger||

    >>>most of these vets voted for the bastard

    do they get GM now?

  • loveconstitution1789||

    Notice the MSM is not covering this in depth.

    It would give Trump even more support since he nominated a VA guy to get rid of dead weight at the VA and there is a lot of dead weight at the VA.

  • Magnitogorsk||

    But what were the numbers in previous years? Hard to tell if this is actually an improvement or not with no context

  • 68W58||

    Hopefully Kimberly Graves and Diana Rubens were among them. Up until now no one could figure out how to fire them after they scammed $400,000 in "moving expenses".
    http://www.washingtonexaminer......rom-agency

  • Diane Reynolds (Paul.)||

    I wonder what premiums would do if we could tweak it out of existence.

  • Dillinger||

    >>> In some ways, it is working better than ever.

    only when dead, working better than ever.

  • loveconstitution1789||

    It still does not work as good as paying cash for all minor medical stuff and catastrophic health insurance for major medical stuff.

    End Medicare, medicaid, and Obamacare!

  • Mithrandir||

    Yep. Nothing brings down premiums more than people knowing what they're actually paying for.

  • ThomasD||

    "better than ever"

    And Suderman was the toughest kid in the Glee Club.

  • Ken Shultz||

    It will be interesting to see what happens going forward as Medicare and Social Security take up a larger and larger portion of GDP. Interesting also if and when higher inflation rears its ugly head and the three of them (Medicare, Social Security, rising interest on our debt) crowd out more and more spending on other things.

    I maintain that ObamaCare was a Medicaid expansion with regulations thrown on top in a stupid bid to make that expansion palatable for the insurance market, and if we find ourselves in a squeeze come the next recession, don't be surprised if ObamaCare in that sense--the Medicaid expansion--get the axe, inshallah.

  • JFree||

    if we find ourselves in a squeeze come the next recession, don't be surprised if ObamaCare in that sense--the Medicaid expansion--get the axe, inshallah.

    No idea what planet you're coming from. In a recession, tons of people lose their existing coverage - and employers tweak their existing plan eligibility to eliminate part-timers or low-income or other groups where there is no need for them to offer an exec-level plan to recruit talent. So the next recovery means it takes a lot longer for the labor market to tighten up to the point where people who lost coverage get it back. That's the dynamic that is gonna put the squeeze on - but it leads to 'single-payer' or 'Medicare for all' or somesuch not to anything else.

  • Ken Shultz||

    The squeeze comes when demographics and inflation mean they have to choose between cutting social security, Medicare, or Medicaid. In that trade-off, Medicaid is the odd man out. Like I said, ObamaCare was primarily an expansion of Medicaid.

  • JFree||

    They're not going to cut Medicaid. They are going to expand the entire system to include young healthy people (the profit center in all public medical systems). And they are going to change the pricing from flat-fee (our current clusterfuck) to a %-of-income system. At which point, employers will be happy to get rid of the entire mess on their side in exchange for a predictable payroll tax.

    What happens after that? Well that depends entirely on what people get elected, what voters see as the priorities, and how much longer the US can play the let's screw the next generation via debt game.

  • Robert||

    Anybody here, or anywhere you know, have ideas for some incremental reforms that could get bipartisan support?

  • Diane Reynolds (Paul.)||

  • Jerryskids||

    You get more of what you subsidize, less of what you penalize. The obvious solution is to make it illegal to get sick.

  • chemjeff radical individualist||

    Expansion of HSA's.

  • Cry more||

    Yeah, you could fuck off Hihn.

  • XM||

    Someone should find out if consumers are actually transitioning to the "cheaper, unregulated" plans. Lefties once howled that killing the individual mandate would sink ACA, but if alternatives are there, some people might take them.

    Why are premiums stabilizing when enrollment is down and subsidies are being threatened? I'm guessing that Trump's tax cuts had something to do with it. If people are choosing cheaper plans with less mandated coverage (or even dropping coverage completely), maybe that allowed for some wiggle room for the insurers.

    Medicaid expansion and tax credits still add to the deficit. A 1 to 2 percent decline in premium can't quite make up for years of increases. Trump undid some restraints placed on the market and the insurers are providing more choices in an improved economy. But he didn't significantly reduce the spending side.

  • Cry more||

    Trump fixed it.

    God damn how you must hate having to admit that.

  • Echospinner||

    Nothing is fixed.

    The Obamacare market is stable for now. So was General Electric couple years ago.

    I bought it when I was working as an independent contractor. I know what it is.

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