A wide array of groups that partnered for several years with the Department of Health and Human Services (HHS) and the White House to promote open enrollment under the Affordable Care Act say this year has brought a deafening silence from the Trump administration, with no sign the partnerships will continue.

Both representatives of the former partner groups and former HHS officials say the relationships with gig economy companies, youth organizations, churches, women’s groups, and African American and Latino civil rights non-profits were critical to keeping Obamacare’s markets functioning, and their termination is a clear example of sabotage.

“The failure to invest in local assistance and these enrollment partnerships will reduce enrollment, increase costs and drive up the uninsured rate,” warned Andy Slavitt, former head of HHS’ Center for Medicare and Medicaid Services under President Obama. “Hopefully they will reconsider taking these destructive actions.”

Without the partners’ help reaching out to young and healthy people who are less likely to sign up for health care, Slavitt explained, the government will find itself with a drastically smaller, older, sicker individual market with sky-high insurance rates.

With the first full open enrollment period of the Trump administration on the horizon, HHS has the power to make good on the president’s repeated promise to “let Obamacare implode”—either through active sabotage or passive neglect. Already this year, the administration has yanked PSAs about insurance deadlines, killed contracts for programs in 18 cities that helped people enroll, and redirected funds meant for the promotion of Obamacare toward the creation of ads against it—a decision now under GAO scrutiny. Both the president and HHS Secretary Tom Price frequently and publicly trash the law.

Now, dozens of organizations say the federal government has abandoned the collaborative outreach and education work they have pursued since 2013, putting the viability of the individual market in jeopardy.

‘Stark Contrast’

Early last summer, the Obama HHS blasted out a press release touting partnerships with dozens of outside organizations and the work they were doing together to encourage young people to sign up for health insurance. By early August of 2016, the coalition was meeting regularly with HHS staff in D.C. and regional federal officials in Los Angeles, Houston, Chicago, Denver, and New York.

But since Trump took office, the partner groups tell TPM, they haven’t yet heard a peep from the administration about the future of those partnerships or any plans for outreach this fall.

“It feels like someone has slammed on the brakes and we’re all lurching forward,” said Amanda Hooper, the director of engagement and mobilization with the National Women’s Law Center, who had worked with the government on every open enrollment period since the launch of the exchanges in 2013. “It’s completely night and day—working with an administration that’s invested in ACA and getting people covered and the Trump administration, which is actively working to take health care away from millions of people. It’s a stark, stark contrast.”

The partnerships to promote open enrollment took many forms. Last year, the NWLC worked with HHS to develop holiday-themed social media campaigns to encourage insurance signups. In 2013, Young Invincibles worked with HHS on a video contest where young people could win thousands of dollars in cash prizes for talking up the benefits of Obamacare for people under 30. In 2014 and 2015, Voto Latino, another former partner group, held a livestreamed Q&A with then-HHS Secretaries Kathleen Sebelius and Sylvia Burwell.

While many of HHS’ past partnerships around open enrollment promotion were with progressive advocacy groups—groups with which Trump administration would likely not want to associate—the relationships with non-partisan professional, religious and medical organizations and private corporations appear to have been dropped as well.

The United Methodist Church, the American Congress of Obstetricians and Gynecologists, the American Medical Student Association, the National Urban League, the National Latina Institute for Reproductive Health, the National Hispanic Medical Association, and the National Partnership for Women and Families—groups that worked with the Obama administration to promote open enrollment—all told TPM they have not yet had any contact from the Trump administration.

There is also no indication that the campaigns the Obama administration launched last year with dozens of so-called “gig economy” companies like Lyft, Uber, Doordash and TaskRabbit to encourage workers and customers alike to sign up for health insurance will continue.

“We have not heard anything about open enrollment from HHS yet,” an official at one of these gig economy companies, who spoke on condition of anonymity so as not to jeopardize future relations with the Trump administration, told TPM. The company official added that a monthly newsletter HHS used to send to partner groups with information about open enrollment promotion has similarly petered out.

“That stopped in January,” he said. “I’ve only received two emails since new administration came in, and both emails have been around the opioid crisis. Nothing about enrollment. That’s been the extent of their outreach.”

Daniel Bouton, manager of a Texas consortium that helps people sign up for insurance, told the Washington Post that the only answer he received when he asked HHS about their intention “is they were working on it, and they hadn’t made a final decision about whether they were going to have a marketing campaign this year.”

HHS did not respond to TPM’s inquiry about the fate of the partnerships and their plans for open enrollment promotion.

High Stakes

While the vast majority of Americans have health insurance either through an employer or through the federal government’s Medicare, Medicaid, and CHIP programs, Obamacare’s greatest challenge has been ensuring that millions of people who fall outside of those categories sign up for health insurance on the individual market. The fewer young and healthy people who enroll, the more unstable those markets will be. If only people who immediately need health care sign up, insurance companies will jack up their rates to cover that cost.

That, says former Obama White House health care policy adviser Chris Jennings, is the danger of scaling back partnerships and joint outreach efforts.

“You’re undermining one of the legs of the stool of enrollment,” he told TPM. “The idea that you would chop that leg off in an obvious moment of confusion and transition sends extremely troubling messages to the targeted population and undermines confidence that we will come close to matching past enrollment numbers.”

A new poll by the Kaiser Family Foundation found that a whopping 80 percent of respondents, and 65 percent of Republicans, “disapprove of the Trump Administration stopping outreach efforts for the ACA marketplaces so fewer people sign up for insurance.”

Jennings warned that if the Trump administration continues to let the partnerships languish, it will have severe consequences. “Particularly for difficult to reach populations, the experienced, trusted community partners can be the difference-makers between a successful open enrollment period and one that underperforms,” he said. “Without them, you will inevitably have a less diverse, more sick population that decreases the stability of the insurance pool.”

In January, when the Trump administration halted outreach efforts during the crucial final days of open enrollment, the move significantly suppressed enrollment by hundreds of thousands of people. Now, amid ongoing uncertainty about the Trump administration’s commitment to upholding the ACA, the former partner groups say reviving their collaboration is crucial to the law’s survival.

“Hopefully they’ll be willing to partner with us and do some promotion this year,” Erin Hemlin with the former federal partner group Young Invincibles told TPM. “The federal government clearly has a bigger reach than we do. It’s so important that they provide as much information as they can to people about what their options are.”