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Same as it ever was, same as it ever was...


Open enrollment for the Affordable Care Act's individual healthcare plans begins, as it does every year, November 1. That's when people sign up on the state and federal exchanges for insurance for 2018. But this year, there are a few changes to be aware of! For one thing, the current president and his secretary of Health and Human Services, Tom Price, hate the ACA and are trying to kill it even though it remains the law of the land. For another, because they hate the ACA and anyone who uses it, you lousy takers, they've cut the open enrollment period in half, from 90 days to 45 days, which means that the last day to buy insurance for 2018 will be December 15 instead of of January 31 like it used to be. Oh, yes, and one more thing: Since Team Trump hates the ACA, anyone using it, and their family too, AND because Team Trump is utterly incompetent, the ACA's fifth enrollment period will almost certainly be marked by confusion, contradictory communication, and widespread disorder. Not because the ACA is broken, but because Team Trump hates the ACA and would far rather break it than be bothered administrating a law they hate, even if it is the law.

Will you be able to tell the difference between ACA problems caused by the administration's hatred of the law and those caused by its incompetence? Maybe. But it won't make a difference. The more problems this year's ACA enrollment has, the more "proof" Trump will have that it's a broken system. We wouldn't be surprised to learn that, as a boy, Donald Trump might have demanded a new puppy after breaking three legs on the puppy he had. (It's a sick thought, we know, but be of good cheer: there's no evidence Trump has ever had a pet of any kind, and we have to think no self-respecting dog would ever have him.) Donald Trump breaks things and complains that they're broken, and let us be the ten thousandth blogger to notice his similarity to Tom and Daisy in The Great Gatsby:

They were careless people, Tom and Daisy -- they smashed up things and creatures and then retreated back into their money or their vast carelessness, or whatever it was that kept them together and let other people clean up the mess they had.

Donald Trump is like that with American healthcare, because he doesn't like it or understand it. But because he understands power, with a low brutal cunning, he understands he can squeeze some of the ACA's key features, the things that make it work, however imperfectly, and make the system more likely to fail. When he says Obamacare is dead, that's not an actuarial assessment, it's an aspiration. As the Congressional Budget Office has said, the ACA is likely to remain stable for the foreseeable future. Unless maybe Trump shoots it through both kneecaps, strangles it, and leaves it to die in an alley.

So, is the government going to be ready to start enrolling millions of Americans in half the time come November? They're not saying. In a Washington Post story that's required reading for anyone trying to make sense of healthcare, virtually all answers to questions about what HHS is planning for this fall's open enrollment come down to variations on "we don't know / can't comment on that yet."

There are some encouraging signs: as you move down from the political appointees toward the long-term civil service staff, it looks like they're preparing for open enrollment as normal. In June, they convened their annual meeting with "navigators" who help people sign up and select plans. They even told the navigators their annual grants would continue as usual. But, oops, there's also this:

Officials provided no assurances at that meeting, however, about whether the administration would continue the government’s other usual enrollment activities or promotion [...]

“Every time the question was brought up . . . the only answer we received 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,” said Daniel Bouton, manager of a consortium that helps people enroll across North Texas.

[wonkbar]<a href="http://www.wonkette.com/611005/trump-kills-paid-for-obamacare-ads-days-before-deadline-because-nobody-needs-insurance"></a>[/wonkbar]This is the administration, remember, that tried to cancel ads -- which had already been paid for -- to remind people in January that the end of the enrollment period was approaching. And which has been diverting funds for public service announcements to make videos about how much Obamacare sucks. The ads were restored after public outcry, but there's no telling what kind of notification will be done this year.

But wait! There's more! The government hasn't even said whether it will notify currently-enrolled policyholders that the open enrollment period has been chopped in half, or whether the call centers or computer systems for healthcare.gov will be tweaked to accommodate the usual number of people in half the time. And then there's this:

How will automatic enrollment be handled? In previous years, notices have been sent out in mid-December, informing customers with coverage about price changes for their current health plan and urging them to shop around. This year, Dec. 15 is when enrollment will end.

Will that be changed? Nobody knows. If people assume they have until December 30 to sign up, that's their problem, the lazy takers. And that's leaving aside the absolutely vital question of whether Trump will fund the premium subsidies for about 7 million lower-income people buying insurance on the exchanges. Donald Trump has lied about those “cost-sharing reduction” payments, a central part of how the ACA works, calling them a "bailout" for insurance companies, which is about as accurate as calling soldiers' pay a "bailout" for the Army. But if he calls them a "bailout" instead of a required part of the program, maybe he can get his Idiot Horde to cheer if he cuts them off and crashes the market. Will he do it? He might! No saying.

The uncertainty about that very basic question, of course, comes as insurers face a deadline to finalize plan details for 2018, without knowing whether a huge portion of their costs will be covered. If the uncertainty leads them to raise premiums, which it almost certainly will, then Trump can point and say Obamacare is failing.

If millions of people's healthcare weren't at risk, the administration's deliberate confusion and obfuscation would be funny. Instead, let's go for infuriating:

Federal health officials declined Thursday to answer questions about a half-dozen specific facets of the impending enrollment season. Instead, a spokeswoman for HHS’s Centers for Medicare and Medicaid Services issued a generic statement: “As open enrollment approaches we are evaluating how to best serve the American people who access coverage on HealthCare.gov.”

An hour later, the spokeswoman, Jane Norris, requested that the statement be withdrawn, saying that she did not have permission to release it. Asked again for detailed answers, neither she nor anyone else at HHS responded further.

Yep, she had to retract a bland statement saying HHS was evaluating how to best serve people. Maybe they're evaluating how best to fuck people over.

Maybe next year, those still wanting to register for the ACA will have to show up in person at one computer in their state's capitol, the Tuesday before Thanksgiving. It might even be plugged in.

Yr Wonkette is supported by reader donations, and we know what we'll be doing November 1: asking you to click the Donate clicky.

[WaPo / Business Insider / WaPo]

Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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