2018 MIDTERM ELECTION

Time: D H M S

Effective 2018, the ACA must be known as "TrumpCare".

UPDATE 7:00pm 1/26/17: Welp. This puts the nail in the coffin:

The Trump administration has pulled the plug on all Obamacare outreach and advertising in the crucial final days of the 2017 enrollment season, according to sources at Health and Human Services and on Capitol Hill.

Even ads that had already been placed and paid for have been pulled, the sources told POLITICO.

...Individuals may still sign up for Obamacare plans until the Jan. 31 deadline — but the Trump administration isn't advertising that fact any longer.

It is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

Ron Pollack, executive director of Families USA, a consumer group that supports the law, called the decision "a mean-spirited effort that can only result in fewer people getting coverage who need it."

...The last five days of the open enrollment season are seen as critical because many individuals procrastinate and then join a last-minute sign-up surge. That’s particularly true for younger and healthier customers who are crucial to making insurance markets work.

...The decision to scrap Obamacare outreach and advertising came directly from the White House, according to sources.

This seals it. Effective Immediately, the Affordable Care Act can no longer be rightly referred to as "Obamacare". Donald Trump and the Republican Party are now responsible for every enrollment shortfall, every person who misses the deadline, every lost CSR reimbursement, every missing APTC payment, every quarterly carrier loss and, especially, every worsening of the individual market risk pool which causes 2018 premium increases and/or carriers to pull out of the exchanges or the entire individual market.

Original story (with tons of evidence leading to the above conclusion) below.

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In mid-December, a Republican consultant openly admitted that the Republican Party planned on sabotaging the ACA, then trying to pin the blame on the Democratic Party when it "collapsed".

...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.”

Last Friday, within hours of taking office, Trump signed an executive order commanding the HHS Dept., along with every other department of the federal government, to do everything in it's power to sabotage, disrupt and generally worsen the implementation of the Affordable Care Act as much as possible until it's actually repealed (whether or not a replacement is in hand).

On Sunday, on one of the morning talk shows, Trump advisor Kellyanne Conway openly stated that yes, the Trump administration may very well go out of their way to try and create a healthcare death spiral in the coming months whether the Republican-controlled Congress actually takes legislative action to repeal the ACA or not.

On Tuesday, health insurance carrier and major ACA exchange participant Molina Healthcare confirmed that the Trumpublican plan to sabotage the exchanges is already starting to have the desired effect: Just 3 months after stating that their exchange enrollees are profitable and that they expected 2017 to be "another solid year" for their exchange business, they're now saying that due specifically to the massive uncertainty about the future of the law and a lack of confidence about what the Republican Party has in mind, they cannot guarantee that they'll even be participating in the ACA exchanges next year.

On Tuesday, it's also vitally important to note, both the Congressional Budget Office and a senior fellow at the American Academy of Actuaries agreed that to the very best of their abilities, they would NOT expect there to be a significant "death spiral" on the individual market IF THE ACA IS KEPT IN PLACE AND IMPLEMENTED WITHOUT BEING SABOTAGED:

Again, this is all speculative, but the bottom line is that the CBO is stating pretty clearly that with the ACA, while they don't see the individual market being in the greatest shape, neither do they see a death spiral under the current law.

On the other hand, a week or so back the CBO issued another report speculating on the impact of the ACA being partially repealed...and the prospects were far grimmer:

...Yet non-partisan healthcare groups that have studied the law say that while [the ACA] has some serious problems and faces challenges, they do not see it as collapsing into a death spiral.

The American Academy of Actuaries is a prime example.

The group, which represents the people who analyze data for insurance companies, says there is no evidence that ObamaCare is in a death spiral or that it is on the verge of collapse.

“I don’t really see evidence of that happening right now,” said Cori Uccello, the organization’s senior health fellow.

...“Obviously, 2016 is not a death spiral,” said Deep Banerjee, an S&P analyst and one of the authors of the report. “We don’t think 2017 will be a death spiral either.”

...Some analysts think Republican repeal efforts actually could make things worse.

This brings me to last night's rambling, terrifying, surreal Trump interview on ABC.

First off, let's be clear about something: Trump's words are verbal diarrhea. Sometimes they have meaning, sometimes they're random blathering. No one (including himself) ever knows which is which, and even if it has meaning one moment, he could change his mind the next.

That being said, Trump confirmed everything noted above: His 2-part "plan" for "fixing" healthcare is to 1) do everything possible to sabotage the ACA as it now stands, and to then 2) literally "sit back and let it explode", then try to blame the Democrats for the very destruction that he and the Republican Party deliberately created:

DAVID MUIR: Let me ask you, Mr. President, about another promise involving Obamacare to repeal it. And you told The Washington Post that your plan to replace Obamacare will include insurance for everybody. That sounds an awful lot like universal coverage.

PRESIDENT TRUMP: It's going to be -- what my plan is is that I wanna take care of everybody. I'm not gonna leave the lower 20 percent that can't afford insurance. Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and -- and the Democrats will vote for it. Believe me.

Because this year you'll have 150 percent increases. Last year in Arizona 116 perecent increase, Minnesota 60 some-odd percent increase. And I told them, except for one problem, I wanna get it fixed. The best thing I could do as the leader of this country-- but as wanting to get something approved with support of the Democrats, if I didn't do anything for two years they'd be begging me to do something. But I don't wanna do that. So just so you unders-- Obamacare is a disaster.

I want to take a moment to note that this "116% increase in Arizona / 60-odd% increase in Minnesota" stuff has some basis but is extremely cherry-picked and misleading (shocker, I know). The weighted average rate hikes for unsubsidized policies in Arizona and Minnesota this year are around 57% in each state. That's obviously still pretty damned high, but it's nowhere near 116% (and there's not a single state where there was a "150% increase"). And again, that refers to the unsubsidized average, which only hits half the individual market; the other half are mostly shielded from those increases.

Oh, and in case you think I'm not a reliable source for this data, guess where Trump claims to have gotten his numbers from? That's right: Me:

But it gets even better: Not only does Trump contradict his own source (namely, me), he can't even do that correctly. Check out this tweet of his from yesterday:

Obamacare is a disaster - as I've been saying from the beginning. Time to repeal & replace! #ObamacareFail

— Donald J. Trump (@realDonaldTrump) October 25, 2016

As you can see, to his "credit", Trump actually did attempt to credit ACASignups.net as his source. However, he couldn't even do that right; he listed the link as ACA.Signups.net instead of ACASignups.net. I'm sure the folks at Signups.net received a lot of confused visitors yesterday.

However, there's something else worth noting. Here's the original version, which ran in USA Today last week:

Aside from the misspelled domain name, it took me a moment to figure out why someone in Trump's campaign even bothered revising the map in the first place by superimposing it over a Bing sattelite map. I mean, they didn't change the actual state by state numbers, so what was the point?

However, there's an easy answer to that: Notice that not only did Trump strip away the caveats at the bottom (weighted averages, market share, 100% renewals, etc)...but he also removed the key word "UNSUBSIDIZED" from the title.

Ironically, I insisted that USA Today include "unsubsidized" on the map graphic itself specifically to avoid the sort of misleading map that Trump, of course, went with anyway.

Now, the truth is that the ugly rates above are accurate for about half of individual market enrollees (roughly 8-9 million people)...but for the other 9 million or so who are subsidized, it's mostly much ado about little.

But I digress.

Back to last night's interview:

It's too expensive. It's horrible health care. It doesn't cover what you have to cover. It's a disaster. You know it and I know it. And I said to the Republican folks-- and they're terrific folks, Mitch and Paul Ryan, I said, "Look, if you go fast -- and I'm okay in doing it because it's the right thing to do. We wanna get good coverage at much less cost." I said, "If you go fast we then own Obamacare. They're gonna put it on us. And Obamacare is a disaster waiting to explode. If you sit back and let it explode it's gonna be much easier." That's the thing to do. But the right thing to do is to get something done now.

I cannot stress enough the importance of understanding that IF Obamacare does "explode" over the next two years, it will not be because the law fails by itself, but will be because Donald Trump and the Republican Party DELIBERATELY SABOTAGED IT.

They said they were going to do so. They will do so. And then they'll sit back and try to play innocent, falsely claiming "See? We told you it was collapsing by itself!!"

A few other oddball points regarding the ACA portion of the interview:

DAVID MUIR: But you ...

PRESIDENT TRUMP: So I wanna make sure that nobody's dying on the streets when I'm president. Nobody's gonna be dying on the streets. We will unleash something that's gonna be terrific. And remember this, before Obamacare you had a lot of people that were very, very happy with their health care.

"Unleash". Has the term "unleash" ever been used to describe something "terrific"? Just asking.

And now those people in many cases don't even have health care. They don't even have anything that's acceptable to them. Remember this, keep your doctor, keep your plan, 100 percent. Remember the $5 billion website? Remember the website fiasco. I mean, you do admit that I think, right? The website fiasco.

For what it's worth, the "$5 billion website" actually cost about $3.5 billion, which is still certainly quite a bit of money, but that's a 30% exaggeration. Just saying.

Also, while it's true that the initial launch of HealthCare.Gov was indeed "a disaster" (only 6 people signed up on lauch day)...that was then. This is now. On 12/15/16, in a single day, HealthCare.Gov enrolled 670,000 people...or literally 112,000x more than just 3 years earlier. Again, just saying.

Obamacare is a disaster. We are going to come up with a new plan ideally not an amended plan because right now if you look at the pages they're this high. We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost.

DAVID MUIR: Last question because I know you're gonna show me around the White House. Last question on this. You've seen the estimate that 18 million Americans could lose their health insurance if Obamacare is repealed and there is no replacement. Can you assure those Americans watching this right now that they will not lose their health insurance or end up with anything less?

Not sure where Muir is getting his 18 million estimate. The lowest estimate I've seen is at least 20 million. My own best guess is around 25 million. Estimates from the Urban Institute and the Congressional Budget Office are around 30-32 million.

PRESIDENT TRUMP: So nobody ever deducts all the people that have already lost their health insurance that liked it. You had millions of people that liked their health insurance and their health care and their doctor and where they went. You had millions of people that now aren't insured anymore.

There have been a few million people who did lose their existing coverage due their existing plans not being ACA-compliant over the past few years. The vast majority of those people transferred over to different policies...myself included. None of which has a damned thing to do with how many would lose coverage NOW under a repeal/no-replace scenario (and even if there is a replacement, they'd still have to shift to a different policy once again, I would imagine).

DAVID MUIR: I'm just asking about the people ...

PRESIDENT TRUMP: No, no.

DAVID MUIR: ... who are nervous and watching ...

PRESIDENT TRUMP: We ...

DAVID MUIR: ... you for reassurance.

PRESIDENT TRUMP: ... here's what I can assure you, we are going to have a better plan, much better health care, much better service treatment, a plan where you can have access to the doctor that you want and the plan that you want. We're gonna have a much better health care plan at much less money.

And remember Obamacare is ready to explode. And you interviewed me a couple of years ago. I said '17 -- right now, this year, "'17 is going to be a disaster." I'm very good at this stuff. "'17 is going to be a disaster cost-wise for Obamacare. It's going to explode in '17."

And why not? Obama's a smart guy. So let it all come do because that's what's happening. It's all coming do in '17. We're gonna have an explosion. And to do it right, sit back, let it explode and let the Democrats come begging us to help them because it's on them. But I don't wanna do that. I wanna give great health care at a much lower cost.

No. You own it now. You owned it the moment you signed that executive order, and the GOP owned it the moment they started voting on bills to repeal the law. Those moves by themselves have disrupted the market. Whatever "explosion" occurs starting in 2018 is entirely on Trump and the GOP now.

And it's not just Trump, mind you. GOP Representative Pete Sessions admitted this yesterday:

Interviews with more than a dozen GOP lawmakers revealed a clash of expectations between rank-and-file lawmakers to get started in disassembling Obamacare and party leaders who are all too aware of the obstacles and difficult choices ahead.

“Exact, specific and detailed — that’s what people want,” said Rep. Pete Sessions (R-Tex.), the chairman of the House Rules Committee. “We’re going to own this stuff, and we better be able to explain it.”

In other words...

With public statements & exec orders that depress enrollment & confuse health plans....

I think the ACA can no longer be called Obamacare. pic.twitter.com/2dvJUbXUVS

— Andy Slavitt (@ASlavitt) January 23, 2017