Trump’s Sensible Health-Care Actions

National Review Online

Friday, October 13, 2017

‘Sabotage” is the prevailing cry from liberals after a series of executive actions by President Trump on Obamacare. To the contrary, the steps he has taken are sensible and, in one case, obligatory. But they also point to the continuing need for legislative action to replace Obamacare.

The most controversial step Trump has taken is also the most defensible. Trump decided that the government would stop making “cost-sharing reduction” payments to health insurers. Obamacare was written to include these payments, but it did not actually put up the money — doubtless to keep the price tag low enough to get it passed.

Congress has never appropriated the money, so the executive branch should not have sent it to insurers. A federal court has even ruled as much. Yet President Obama — and, unfortunately, President Trump — made the payments. It is right that they be ended now. The consequences, according to the Congressional Budget Office, are that premiums will increase in the individual market. Most policyholders will be shielded from that increase by increased Obamacare subsidies; some will even come out ahead. That’s bad news for taxpayers, but that liberals can present it as a catastrophe with straight faces is mostly a testament to their dramatic skills.

Another executive action liberates “association health plans.” The importance of this step has been exaggerated, both as a boon and a menace, because the same term was used in the past to describe an older, more expansive idea. All it seems to be doing is instructing regulators to allow small employers to band together to offer their employees insurance. If they do they will receive the same freedom from state governments’ regulatory mandates that large employers do. It is a modest step that should boost coverage numbers, although it is possible that it will cause premiums on Obamacare’s exchanges to rise a bit.

A third action begins to loosen the rules on short-term health insurance and makes it possible for it to be renewable. Depending on how the market for this kind of insurance develops, new rules really could destabilize Obamacare’s exchanges by pulling young and healthy people out of them.

These actions all underscore a weakness of Obamacare. It limits choices and raises premiums, but makes it impossible to address these problems without threatening other parts of it. Its proper functioning requires policymakers to give it subsidies and write regulations to close off avenues by which consumers could escape it — even when the statute itself does not require these regulations or fund these subsidies; even when the additional support violates the Constitution.

Even before these actions, liberals were crying that Trump was undermining Obamacare by limiting open-enrollment periods and cutting back on outreach to get people to sign up. Perhaps a law that requires its opponents to nurture it was not especially well-designed?