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Funding cuts, premium increases and the future of Obamacare

President Trump’s effort to eliminate the Affordable Care Act was stymied by the Senate last year, but he hasn't stopped trying to undermine it. William Brangham asks New York Times health care correspondent Margot Sanger-Katz about recent funding reductions for enrollment navigators, whether coverage for preexisting conditions is in jeopardy, and the future of the ACA.

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  • Judy Woodruff:

    Now, the Trump administration's efforts to undercut the law often referred to as Obamacare.

    Yesterday, administration officials said they will cut funding to an outreach program that helps individuals sign up for coverage. They say that outreach is no longer necessary.

    As William Brangham explains, it's latest in a series of moves to strike back against a program the president remains vehemently opposed to.

  • William Brangham:

    Mr. Trump was frustrated when the Republican-led Congress was unable to squash the Affordable Care Act outright.

    But the president, who says he's against the law philosophically, hasn't stopped trying to knock it down. Funding for these so-called enrollment navigators has been cut by 85 percent to just $10 million. The administration has also suspended payments to insurance companies to compensate them for caring for sicker patients. That move came after a pair of court rulings about these payments.

    And the Justice Department has sided with the state of Texas in a separate lawsuit arguing that protections for people with preexisting conditions should be eliminated.

    Margot Sanger-Katz writes about this for The New York Times Web site.

    And she joins me now.

    Thanks for being here.

  • Margot Sanger-Katz:

    My pleasure.

  • William Brangham:

    So, let's talk about the first of these changes. These are the cuts to the so-called enrollment navigators.

    Who are these people, and what do these cuts mean?

  • Margot Sanger-Katz:

    So, this was a program that was set up under Obamacare because there are all these people who hadn't had health insurance before. Many of them didn't really have experience buying it.

    And so the law wanted to set up people who could give them advice, who could walk them through the process, help them understand what's a deductible, what is a premium, can I get a subsidy to help me buy insurance?

    And so it set up a grant program to pay community groups, disease advocacy groups, health care providers, basically pay them to have personnel to just walk people through process of enrolling for health insurance.

    And the Trump administration has now twice cut back the funding for that program. They say that it's not very efficient, that the navigators haven't been very good at signing people up for insurance, and that it would be best to just let brokers and other people whose job it is to do this.

  • William Brangham:

    So, is the expected impact that if they're cutting money to the navigators, that less people are going to enroll?

  • Margot Sanger-Katz:

    I think that is one concern.

    Certainly, the navigators themselves and some consumer advocates feel like this is just part of a pattern of chipping away at the tools that are going to help drive enrollment in these programs.

  • William Brangham:

    Another one of right changes that was announced this past weekend was the Trump administration is going to limit payments that are made to insurance companies.

    Can you explain what these payments are and what they were meant to do?

  • Margot Sanger-Katz:

    Yes.

    So, under Obamacare, everyone can get insurance, regardless of whether they have preexisting conditions. And this is a program that basically transfers money from insurance companies that end up with a lot of healthy patients to insurance companies that end up with a lot of sick patients, so that everyone can make money regardless of who signs up for their plans.

    So, the results of this are actually kind of interesting, because not every health insurer is disadvantaged. The ones that were going to have to pay now get to keep more money. They're doing better.

    But what it does, it tends to throw a lot of uncertainty into this market, because these insurers were really counting on these payments in order to make money and stay viable.

    And I think, fundamentally, it's also bad, because the whole system depends on these insurance companies wanting to participate in these markets. There is no federal fallback. There is no public option. The only way there is going to be Obamacare insurance is if private companies want to sell insurance.

    And this is kind of a form of pulling the rug out from under them.

  • William Brangham:

    The president, as I mentioned, was very frustrated when Congress really couldn't just undo the law totally.

    And they have kept trying to chip away at it. And yet enrollment numbers last year were still pretty robust. I think it was, what, nine or 10 million people. This law still seems to be resilient, despite the attacks against it.

  • Margot Sanger-Katz:

    I do think it's been a bit of a surprise how resilient these markets — in particular where people buy their own insurance. There just have been so many blows against them over the years. And they seem to kind of still be standing.

    I think in some ways they're not as good as people had hoped. Insurance has gotten really expensive. We have seen two years in a row of very large premium increases. So, if you're someone who buys your own insurance, and you don't get a government subsidy, you're really facing some serious sticker shock. There's going to be some price increases again for next year.

    I think there is also less choice and competition than the people who wrote the law had hoped for. There was this idea it was going to be like a KAYAK for health insurance, you were going to get to pick from lots of options. And there are many places in the country where there's only one insurer available.

    But I think the fact that there is one insurer everywhere who at least wants to continue to participate, and that there are so many people signing up shows that the government subsidies are adequate to help certain people buy insurance, and also that there are a lot of Americans who really want to be able to buy insurance, and they're grateful to have this program available to them.

  • William Brangham:

    Are there — amongst the supporters of the Affordable Care Act, are there other ways that they're looking that they're worried might be coming down the road, other attempts by the administration to diminish the law?

  • Margot Sanger-Katz:

    Absolutely.

    So, there's really one big one that I think we're going to see come any day now. And this is a plan that would allow insurance plans that don't have to cover all of the Obamacare benefits, that don't have to offer insurance to people with preexisting conditions.

    These are going to be much more liberalized, and they going to become much more common. And I think there are two concerns about these plans.

    One is, consumer advocates really worry that people won't understand what they're buying, so they might buy a plan and then find out later, oh, it only covers $250,000 worth of care this year, or it doesn't cover any kind of maternity or prescription drug benefits, and that they're going to be people who are kind of left in the lurch if they buy it.

  • William Brangham:

    These were things mandated under the ACA.

  • Margot Sanger-Katz:

    These are all things that would be required.

    The ACA plans all have to cover a standard set of benefits, to include drugs, hospitalization, maternity care. And then they also have to provide you with a certain amount of financial protection, so the Obamacare plans can't limit how much they will pay in a year for your medical care.

    So most people don't pay $250,000 worth of medical bills. But if you're one of those people who has a really bad cancer diagnosis, has a child with a genetic disorder or some other serious disease, you want to have that kind of high-end coverage. So, that is one worry.

    But the other worry is that these short-term plans are going to be much less expensive. And so if you're a healthy person, you don't have any preexisting conditions…

  • William Brangham:

    That's a big draw.

  • Margot Sanger-Katz:

    Yes, you could qualify for it.

    I mean, like I said, the Obamacare plans costs a lot of money. For a lot of middle-class people, it's a huge stretch. So, if they can qualify for a cheaper plan, they're, I think, totally rational to go there.

    And what that means is that the pool of people who are left in the Affordable Care Act plans are going to tend to be sicker. And that's going to further drive up premiums and further make the plans unaffordable for people who really want that kind of comprehensive coverage and don't get a subsidy to help them buy it.

  • William Brangham:

    Margot Sanger-Katz, thank you.

  • Margot Sanger-Katz:

    Sure.

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