White House Actions Could Undermine ACA's Insurance Markets

President Trump has vowed to get rid of the Affordable Care Act. But with Congress failing to do that, Trump took action this week that could hurts the program.

SCOTT SIMON, HOST:

President Trump promised during his campaign to get rid of the Affordable Care Act. Congressional Republicans couldn't agree how to do it after several attempts. The president and his administration have taken a series of actions that could undermine the insurance markets that were created by the health care law. The latest came late this week. We're joined now by NPR health policy correspondent Alison Kodjak. Alison, thanks so much for being with us.

ALISON KODJAK, BYLINE: Thanks for having me, Scott.

SIMON: What exactly did the president do this week?

KODJAK: He took two actions. The first was he signed an executive order that he hopes will allow people and businesses to get together and buy health insurances as a group outside the Affordable Care Act marketplaces. And the idea is the group market power can get a lower price. But there's a little problem with that in that most people say that the only way this is going to work is if those groups peel off only the healthy people and leave sicker, more expensive people to continue to buy insurance on those ACA exchanges. So then costs would go up for those sick people. In his second act, he ended these payments of some key subsidies to insurance companies. And they offer discounts to low-income customers. So while the mechanics are complicated. The end result of this second move - most economists say it would end up costing middle-income consumers who buy insurance on those exchanges a lot more money.

SIMON: And of course, let's just note, again, that was just this week. What else has the administration done?

KODJAK: Well, they've taken a whole bunch of actions really since the beginning of the year. The president, right after he took office - the Department of Health and Human Services removed a whole bunch of information from its website about how the Affordable Care Act worked and how people can sign up. And then a few weeks ago, the same agency, HHS, said it was going to cut the budget to advertise for open enrollment for the exchanges by 90 percent. And then during this coming open enrollment period, they've also announced they're going to close the marketplace for about 12 hours every week on Sundays, which would be a time that a lot of people might want to sign up.

SIMON: And you're suggesting that taking it offline for 12 hours is meant to prevent a number of people from signing up?

KODJAK: Well, there are people who criticize the administration and say that's the case. Now, the administration says they need to take the website down on a, you know, routine basis to perform maintenance. There are those who say they could have done at a different time rather than do it on a Sunday when a lot of people are home and might have time.

SIMON: How are all of these changes likely to affect people?

KODJAK: So you know, it's hard to say exactly. With the actions this week, some people may see their premiums rise, especially if they don't get subsidies from the government to help pay for their insurance. And with the rollback in outreach, people could find they don't know where or how to get insurance. I myself have been getting email messages and messages on Twitter from our listeners who are confused about what's going on. But then there's this sort of broader issue. And it's a little harder to pin down. And that's just - there's all this talk about the ACA collapsing, about it being repealed. The president says it all the time. The Department of Health and Human Services tweets about it. And that confusion, you know, could make people think they can no longer get insurance or make them think it's not worth it. So when open enrollment starts, some people just may not sign up.

SIMON: NPR's Alison Kodjak, thanks so much.

KODJAK: Thank you.

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