We made it! And so did the ACA...mostly.
Over at Vox yesterday, Dylan Scott wrote a piece titled "The Trump presidency is over, and Obamacare is still alive" which is worth a read.
Before November 8th, 2016, I was secretly planning on shutting down (or at least mothballing) ACA Signups as soon as the 4th Open Enrollment period was over. Traffic had been gradually dropping off as people got used to the ACA & it started to fade from the headlines. My official day job as a website developer had suffered. What was supposed to have been a 6-month hobby in my spare time had turned into a full-time job, and I had lost web clients along the way. I figured it would be time to wind down ACA Signups & refocus on my web business.
nstead...well, you know what happened. On November 9th, 2016, I changed the header to this graphic, assuming that the ACA was doomed. I even registered ACASignoffs.net and redirected it to the site. I intended to keep the revised header up for 24 hours as a symbolic gesture.
I was immediately flooded with texts, DMs, emails etc. from people pleading with me to keep the site up & running because "it's needed more than ever" etc etc. Instead of 24 hours, I ended up swapping it back again within an hour or so.
In addition, the day after the 2016 election saw over 100,000 people enroll via Healthcare.Gov in a single day. If the ACA was facing imminent death, you'd never know it from the 2017 numbers. And so, the mission of ACA Signups changed a bit.
2017 saw the battle over Obamacare turn into a full-scale war of attrition, as Congressional Republicans crapped out one slapped-together garbage "replacement" bill after another. The Senate version was literally called BCRAP. No, seriously (the Better Care Reconciliation Act Plan).
This chapter culminated in absurdly dramatic fashion with a vote in the wee early hours of July 28th, 2017, when, thanks to every Democratic Senator w/assists from Susan Collins, Lisa Murkowski and John McCain's famous "thumbs down", the ACA was saved.
Trump *thought* he got "revenge" in October 2017 by gleefully doing what he'd been threatening to do all year: "Blow up the exchanges" by cutting off CSR payments...which basically amounts to him stiffing contractors out of payments due, big shocker.
The thing is, Trump didn't know how CSR subsidies work. He thought he was screwing poor people. Instead, he was screwing carriers. His sabotage attempt may have worked anyway IF the carriers had bailed, and at least a few did, like Health Alliance Plan here in Michigan...
...but a funny thing happened instead. Due to the way CSR subsidies, APTC subsidies & policy premiums interact, the carriers, regulators & exchanges came up w/a pricing workaround called "Silver Loading" which solved their problem and made policies more affordable for many.
The GOP *was* able to cut a pound of flesh out of the ACA in Dec. 2017 by zeroing out the federal individual mandate penalty (though the change didn't actually go into effect until 2019)...unsubsidized enrollees were hit with higher premiums as a result.
Howver, even that didn't end up being as bad as expected (I estimated avg. 2019 premiums were ~8% higher than they'd otherwise have been, vs. the 20%+ higher that some had feared). Slashing the marketing & navigator budgets hurt enrollment somewhat, though.
Having failed to kill the ACA legislatively, the Trump Admin, and CMS Administrator Seema Verma in particular, turned to see what they could do to sabotage it administratively instead. First, she opened the floodgates on Medicaid Work Requirements.
Meanwhile, Trump issued an executive order to flood the market with #ShortAssPlans...not merely reversing Obama-era regulations on junk plans, but actively pushing these non-ACA compliant plans *hard*.
Then Verma gutted Section 1332 of the ACA. This section is supposed to allow states to experiment with the ACA as long as doing so provides at least as comprehensive coverage to at least as many people w/out raising the deficit, but she warped the interpretation of the language to do allow pretty much the exact opposite, then pushed states to do just that. So far only one (Georgia) has done so, but others may follow.
There was a BUNCH of other stuff Trump & Verma did to hack away at the ACA around the edges...but to their great frustration, like the first Rocky movie, the law refused to go down no matter how much it was bloodied.
But the Trump Admin. had one more trick up their sleeve: An idiotic lawsuit filed by 20 GOP hack AGs which used an absurdly warped legal interpretation roundly laughed at across the political legal spectrum to try and kill the law: The Texas Fold'Em case.
As stupid as the Texas Fold'Em case is (and believe me, I've written countless times how insanely stupid it is), it somehow managed to make its way all the way to the U.S. Supreme Court, which heard oral arguments one week after the 2020 election. The good news is that in spite of the newly-Trump friendly 6-3 makeup of the Court, the oral arguments did *not* go well for the plaintiffs. Even Justice Alito seemed awfully skeptical that the case had any merit.
HOWEVER...as U of M law professor Nicholas Bagley always says, even a small chance of a terrible thing happening is still a chance. Fortunately, with the White House and (bare) majorities in the House & Senate, there's a rare opportunity for Dems to #MootTheSuit.
Anyway, we'll see what happens. I promise to continue to keep you posted on the latest craziness surrounding the ACA, both good and bad, for as long as I can. One way to help ensure I can keep doing so is to support my work either once or monthly.
And with that, I'm going to start watching the Inauguration Day ceremony which will officially flush the stain of the Trump years and replace it with the decency and competence of the Biden/Harris Administration.