Conway: Yes, Trump/Price may try to deliberately create a Death Spiral, with or without Congress.
"The Democrats are the party that says government will make you smarter, taller, richer, and remove the crabgrass on your lawn. The Republicans are the party that says government doesn't work and then they get elected and prove it." --P.J. O'Rourke, Parliment of Whores
As I noted on Friday, Donald Trump's executive order essentially orders the incoming HHS Secretary (presumably Tom Price), along with other relevant agency heads, to do everything in their power to sabotage the ACA regardless of any repeal legislation (whether partial or total) on the part of Congress. Since the ACA grants the HHS Secretary pretty wide authority about how (and whether) to enforce various components of the law, this gives ample room for the Trump administration to make the individual mandate (among other ACA provisions) effectively meaningless.
This would amount to ripping away...or at the very least, loosening...one of the legs of the "Three Legged-Stool" which form the basis for how the ACA works. A second leg (the financial subsidies) would be killed in the event of a partial Congressional repeal, but the first one can be effectively removed by Trump/Price themselves.
Doing so could cause the very premium "death spiral" that the Republican Party keeps (falsely) insisting has already happened, since removing the mandate penalty tends to cause adverse selection, with younger/healthier people choosing not to sign up, while older, sicker people will still go ahead and enroll. The irony of the ACA is that as it stands, the individual mandate penalty is actually too low to be fully effective; removing it entirely could cause a domino effect for 2018 rates.
In other words: Eliminating/weakening the mandate now leads to adverse selection, which could lead to carriers either submitting massive rate hikes for 2018...or bailing from the exchanges (or even the entire individual market) altogether...even if the GOP doesn't actually officially repeal the law itself. Then, Trump/the GOP can sit back and say "See! We told you it was already in a death spiral!"
I also noted that this should hardly be a surprise, since at least one GOP strategist openly admitted they'd do this back in December:
...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.
“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”
Well, this morning, Trump advisor Kellyanne Conway stated point-blank that yep, they may very well do exactly that:
The Trump administration may stop enforcing the Obamacare requirement that most Americans carry health insurance even before Congress repeals the law, Kellyanne Conway, a top adviser to the new president, said in interviews broadcast on Sunday.
Such a move would take the teeth out of former President Barack Obama’s health-care law and could destabilize insurance markets, analysts say. It was not clear from Conway’s remarks whether President Donald Trump would try to use his executive authority to make the change, which would be much faster than writing new regulations or waiting on lawmakers.
"What President Trump is doing is, he wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans, to have to pay a penalty for not buying government-run health insurance," Conway, whose title is counselor to the president, said Sunday on ABC News’s "This Week"
When host George Stephanopoulos asked her if Trump would "stop enforcing that mandate," Conway responded: "He may."
Trump, Conway, Price, Ryan, McConnell seem to be absolutely convinced that the media and enough of the public is going to fall for this scam that it won't bite them on the ass in 2018...and judging from the fact that Trump managed to pull off an electoral college win and is now President, they may very well be correct.
The only thing about this which I find surprising is that she's so blatantly open about their intentions. Apparently they're so confident in their ability to get away with flinging bullshit they don't even feel a need to try and hide it.
It's also worth noting that this move may or may not have the "desired" effect. It's possible that the mandate penalty (currently $695/person or 2.5% of household income) may actually be too weak for removing it to have a significant impact--that is, it's hard to say how many people are signing up now who otherwise wouldn't have done so without that penalty in place. Every healthcare policy expert I know of seems to agree that it would have some negative impact on premium rates, though.