From Countable

On Tuesday, the seven-year quest by Republicans to repeal and replace the Affordable Care Act, popularly known as Obamacare, appeared to come to an end, and President Trump responded to the setback by vowing to “let Obamacare fail.”

“It’ll be a lot easier,” Trump said at the White House.

“We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.”

With Obamacare entrenched in many states, and numerous governors (and, apparently, senators) supportive of the legislation, what can the Trump Administration actually do to try and tank Obamacare?

END INDIVIDUAL MANDATE

On Wednesday, the nonpartisan Congressional Budget Office (CBO) estimated what would happen if Obamacare were to be repealed without a replacement. The CBO predicts 32 million people would lose insurance by 2026, including 17 million by next year. The CBO also estimated that, compared to current law, premiums would nearly double by 2026. Medicaid expansion would end in 2020.

Much of this was based on the elimination of the individual mandate, which requires all Americans sign up for health care, regardless of age. By repealing the individual mandate, those who would most likely remain enrolled in health care would be those Americans with an immediate health care need: primarily older and sicker Americans. That demographic is the costliest to cover, so this in turn would cause insurers to have to dramatically raise their rates. The Trump administration needs Congress to repeal the individual mandate, but it can direct the Internal Revenue Service (IRS) to soften its enforcement of the mandate.

WITHHOLD PAYMENTS DUE

This is one of the most lethal strategies, and has been referred to as the “Nuclear Option” for killing Obamacare.

Insurance companies are owed billions of dollars in “cost-sharing reduction” payments. Under the ACA, insurance companies reduced the deductibles of low-income customers, with the understanding that the government would reimburse them. According to the Kaiser Family Foundation, in 2016 the federal government paid an estimated $7 billion in cost-sharing payments, on behalf of 6.4 million marketplace customers.

For months, President Trump has been threatening to withhold this money. In response, insurers have claimed they’re already raising 2018 premiums. Some insurers have also warned they may pull out of additional counties if they can’t be guaranteed reimbursement. (There are even a handful of counties that have no individual insurers lined up for 2018.)

Anthem, one of the nation’s leading healthcare providers, decided to exit various markets in June because of all these unknowns. In a statement, the company said their concerns include “continual changes in federal operations, rules and guidance” and “an increasing lack of overall predictability.”

FAIL TO PROMOTE OPEN ENROLLMENT PERIOD

With few exceptions, individuals can only change their insurance, or sign up for new insurance, during the marketplace’s open enrollment period. President Obama made it a priority to spread the word about open enrollment and get people signing up. This included commercials, Tweets, and offbeat interviews, including the one on Between Two Ferns.

By refusing to promote the exchanges, or directing people to sign up, the Trump Administration could cause a steep decline in new enrollees. It’s a more roundabout way of attacking the individual mandate, but one that will cause insurers to take a hit nonetheless.

While Obamacare may or may not be the “disaster” Trump has claimed it to be on numerous occasions, it is in a precarious position: if the ACA is a game of Jenga, Trump certainly has ways to remove some key blocks to help it tumble.

Should the GOP preemptively work with the Democrats on the ACA? Or should Republicans, as Trump suggested, “let Obamacare fail, and then the Democrats are going to come to us”? Tell your reps to save our healthcare.