Okay, I know DC Deciphered is starting to sound like a broken record on the topic of how Trump & the GOP are doing their darndest to destroy Obamacare . . . but I believe this has been the underreported story of the Trump presidency. And things are about to reach emergency status. The ever-expanding Russia story, Trump’s ethics breaches, his daily destroying of democratic norms – and the GOP’s indifference in the face of all of it – that is all huge, and it deserves the massive amounts of attention it’s been getting.
But that’s all big picture stuff – things we likely won’t know the real impact of for months or even years to come, the sort of stuff that might have an enormous effect on our democracy, but for right now, it doesn’t really change our day to day lives. What Trump & the GOP are doing to sabotage Obamacare, on the other hand, will affect millions of lives almost immediately. And until last week, there was very little reporting on it.
When It Rains It Pours
Then suddenly, last week, there was a flood of stories on the topic. Most of them focused on the possibility that Trump will stop reimbursing insurance companies for Obamacare’s cost sharing reductions (CSRs), which help millions of low income customers reduce their out-of-pockets costs. Trump reportedly told his aides recently that he plans to stop making the payments, and that seems to be one reason for the deluge of stories. But some of the recent stories were about the broader ways in which Trump & the GOP have been working to damage Obamacare.
So it’s not entirely clear why suddenly, there’s so much attention on this issue. I think it’s likely due to the fact that right now a bunch of newsworthy things are all happening in this area all at once, including: (1) Trump’s latest threat to stop paying the CSRs (though he’s made such threats several times before), (2) recent significant attempts by the insurance industry to draw attention to the issue, (3) the impending June deadline for insurance companies to make their decisions for 2018 (whether to remain in Obamacare markets and if so, where to set premiums), and (4) a Monday hearing in a court case that could decide the fate of the CSRs.
But Why the Drought in the First Place?
I’m not going to discuss all of those things in detail, because I’ll have several links throughout this post that will do a good job of that. What I want to focus on is the fact that it has been foreseeable for months that we were going to end up here. And “here” is this spot where every person or group who has an interest in the fate of Obamacare is now waiting anxiously on a knife’s edge for pronouncements from Trump to see if Obamacare will live or die.
And it is no small thing to say that this was predictable months ago – that means that this might have been avoided. But now instead, we’ve arrived at a crisis point for Obamacare and the millions of Americans who rely on the health insurance it provides. And to be clear, this scenario puts at risk not just those who rely on the CSR subsidies, but everyone who gets their insurance through Obamacare. Because if the funding for the CSRs stops, it has the potential to destroy the Obamacare markets entirely. So why wasn’t there more attention paid to this? Why did it take until now – when it’s almost too late (or possibly even is too late) to prevent damage – for the media to start reporting on what was happening (other than the rare story here and there*). And more importantly, why weren’t Democrats raising holy hell about it??
Let’s Review What We Already Knew
Back in April, I wrote a series of posts explaining the various ways in which Trump and/or the GOP were damaging or had already damaged Obamacare. Some of the methods were already done, the damage was completed and there was no going back. But some of them were things that were still ongoing currently, and could potentially be mitigated if Trump and/or the GOP could be convinced to do the right thing.
I wrote about the two most prominent examples of these current, ongoing methods in Obamacare Wars – Part 3. These things that I wrote about are the same things that are getting the sudden flurry of media attention right now: Trump’s refusal to commit to reimbursing insurance companies for the CSR payments, along with his refusal to assure them that he will be enforcing the individual mandate. (If you haven’t been following this topic up till now, please read that post if you get some time. In an attempt to keep this current post brief, I’m leaving out a lot of important details and context. That old post will be really helpful in fully understanding the issues addressed here).
I was desperately hoping that some widespread attention might be brought to the fact that the President and his Party were on the cusp of intentionally destroying the insurance markets that millions of Americans – including their own supporters – rely on. And to rub salt in the wound, they were pointing to these failing markets – claiming Obamacare was “imploding” on its own, etc – in order to help sell their heinous Obamacare replacement. But what always went unmentioned in this sales job was the fact that if Obamacare was failing, it was the result of their own handiwork.
A few days after that Obamacare Wars – Part 3 post, the topic of cost sharing reductions did actually get a little burst of attention in the beltway press. But unfortunately it was not very helpful attention, because the media got the story wrong, giving the impression that the CSR issue had been resolved. It began when Budget Director Mick Mulvaney told Minority Leader Pelosi that the Trump administration would stop making CSR payments as soon as the following month (which would have been May). This seemed to come out of nowhere, since until that point everyone had assumed the payments would at least continue through May. Then within hours after that, the White House walked it back and assured Congress that they would indeed be making the payment. This got widely reported as though a real breakthrough had been made on the CSRs, as if the Trump administration had made some sort of new concession or commitment. And even Nancy Pelosi touted it as “making progress.”
Yet in reality, nothing at all had changed. There was still no long term commitment on the issue, no assurances from Trump, he was still free to stop making the payments at any time, which I pointed out in this contemporaneous post. I was very worried about the fact that this was being portrayed as a positive development, because I feared it meant no one would pursue the issue any further. It was an error by the media to portray this as progress, but it was a much worse error by the Democrats. I could not understand why they were allowing this to be sold as though headway had been made. And I still don’t understand it now.
Then, this same “agreement” was touted a week later by the press as being a big “win” for Democrats coming out of the short term budget agreement Congress had just made (and Democrats went along with this telling). So it was once again portrayed as though the issue had somehow been resolved, even though nothing at all had changed, and Trump was still free to change his mind at any moment. At that point, coverage of the issue seemed to stop for the most part. The topic pretty much dropped out of public view after that, getting almost no further attention from the press and almost no public mentions from Democrats.
Now It’s Newsy
Finally in just the last 10 days or so, the issue resurfaced again– and has suddenly gotten a lot of traction — as Trump has begun to re-up his threats to stop the payments (about a week before Friday’s Politico report re Trump telling aides he’d stop paying the CSRs, he had made the same threat publicly in an interview with the Economist). Additionally, the insurance industry and other stakeholders (hospital associations, patient groups, etc), becoming desperate for answers, have started reaching out on their own to both Congress and Trump, pleading with them in letters to continue the payments.
And more and more insurance company insiders have been speaking out to reporters, telling them how the uncertainty surrounding the CSRs (as well as the individual mandate) is affecting their ability to make decisions for 2018. Many of them are disclosing how the lack of information from the Trump administration is forcing them to choose between pulling out of the markets altogether or dramatically increasing premiums.
In addition to all of that, on Monday there will be a hearing in the case of the United States House of Representatives v. Price, which is the lawsuit over the payments of the cost sharing reductions, begun years ago, when Obama was still President. It’s a pretty complicated case, so please read this post post if you’d like the background. But it’s because of this lawsuit (and some poor drafting by the authors of Obamacare) that Trump is able to just decide on a whim whether or not he wants to make the CSR payments. What happens Monday at the hearing could help determine the fate of the payments, or the Trump administration could simply ask for the case to be delayed for a few months, as it already has been before.
But Why Wasn’t Anyone Paying Attention Sooner & How Can We Change That??
And now, having reviewed all of that, there’s a reason I started this post by addressing the fact that this story had gone almost completely unreported until now. As I noted at the beginning, this story is vitally important. If Trump makes good on his threat to end the CSR payments, it will be devastating to millions of Americans who rely on these subsidies (especially Americans living in red states, ironically).
And, as I noted at the outset, it could potentially harm everyone who gets their insurance through Obamacare, not just those who rely on the CSR subsidies, as this decision has the potential to destroy the Obamacare markets completely. So why hasn’t the media been reporting on this? Is there a way that we, as citizens, can get the media to focus on an issue of substance like this that we think hasn’t been given enough attention??
But even more importantly, why haven’t elected Democrats (and those hoping to get elected) been yelling about this for months?? I’m not an expert on these types of things, but as a humble observer, this is where I think Democrats really fall short. Voters – in general, but especially right now – want people in office who are going to help them with the problems that affect them in their daily lives. Health insurance/health care is one of those things. And Democrats actually did a pretty good job when it came to drawing attention to the GOP’s health care bill and how damaging it would be.
But they’ve been almost completely absent when it comes to letting Americans know about the damage Republicans are doing to Obamacare right now. And I’m not sure why that is, since this threat is just as immediate – if not more so – than the passage of an Obamacare replacement bill (especially when you add in the fact that Republicans are diabolically trying to use claims of the “failing Obamacare” to help sell said replacement)**
Democratic officials need to be out there, letting everyone (their own supporters, Trump supporters, independents) know that Obamacare is at risk because of a decision that Trump is about to make. A couple of Democrats have picked up the cause in recent days. But we need all of them to get on tv and Twitter and Facebook and anywhere else they can, and make sure all Americans can hear them. They need to inspire people to make noise opposing that decision, and to hopefully prevent it. And they need to make sure, that if it can’t be prevented, people understand who’s responsible for it.
And if our elected leaders aren’t getting the word out about this, then we need to push them. The media has their job to do, and unfortunately, a lot of the time, that means focusing on the stories that attract the most eyeballs. So that means it may be up to us to find ways to make sure the other important stories are being told just as loudly.
*I should note that there are some great writers and/or advocates who have been on top of this story. Andy Slavitt, Obama’s former CMS head, who’s an adviser the Bipartisan Policy Center and contributes to USA Today and is also a Twitter maestro has been all over this topic. Law professor Nicholas Bagley, who contributes to the Incidental Economist has also done some great explanatory writing on the background of the CSR issue.
And of course there are groups that are dedicated to focusing on these sorts of issues, like the Kaiser Family Foundation, which has been an essential source of information. Then there are a couple of general news sites – Vox & the Huffington Post – whose health care writers have done a good job keeping up with the controversy as well. And I’m sure there are others who I’m momentarily forgetting or not even aware of.
But for the most part, the mainstream media (print, but tv especially), has missed this story. So people who don’t read specialty blogs/sites, or who only have time to glance at headlines or watch the evening news would not have any idea that this was happening.
**Also note that even if the GOP successfully passes a replacement plan for Obamacare, the issues discussed here could still be significant for Democrats and/or those who’ve been relying on Obamacare. As discussed in this post, if the final law the GOP ends up with is similar in structure to the bill that recently passed the House (i.e. leaves an Obamacare-ish default in place, while allowing states to waive out of it), then all of these avenues for sabotage by the GOP will still be available in the states that choose to retain Obamacare.
And the GOP will likely have even more incentive for sabotage at that point, as the scenario will turn into a competition between Obamacare states & Trumpcare states. The worse Obamacare looks, the better Trumpcare will look. Therefore, sabotage galore.
***I’m adding here the same note that I added to my previous post on the topic of CSRs. I want to be really clear that while I’m being critical of the press coverage on this particular issue, I have an extraordinary amount of admiration and gratitude for our press, now more than ever. We have a free country in part because we have a free press. And many of the people working as journalists today (including those whose work I’ve cited as examples in this collection of posts) do really good work at a difficult job that has only gotten harder since Trump has decided to make them the enemy.
So my point with these posts is not to vilify or denigrate the media. It’s impossible for them to get everything right every single time or to cover every topic in depth at every go ’round. But because I think this health care issue is so crucial to so many people, I believe it’s worth pointing out what happened here.
Also, as I mentioned in a note to this previous post, one of the main things I am trying to do with this blog is bring attention to issues that I think aren’t getting enough attention in the mainstream media, or things that are getting attention but where I think the audience might want additional explanation about how things work or why they happen the way they do.
So by definition, that means my posts will often come across as critical of what the media is doing. But it’s because I think many of them have been doing a good job on most things that I’m trying to cover the things they’re not getting to. The stuff they are covering thoroughly doesn’t need a rehashing from me. And I should also note that anything I cover on this blog has been reported on by at least one person in the press, because while I do original analysis, I don’t do my own original reporting (and I will always credit and/or link to them), so I rely on them in order to be able to write about anything that I write about here.