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wonkshop by Doktor Zoom

Donald Trump couldn't manage to repeal Obamacare, so instead he's going for death by a thousand cuts, plus as many knees to the groin and eye-gouges as the administration can manage. Last week, the administration pretended a very technical legal challenge absolutely required an end to payments designed to keep premiums affordable. Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced huge cuts to a grant program that helps people sign up for insurance through the Affordable Care Act -- or rather, another huge cut to the program. It's all Obama's fault, after all, because Obamacare was designed to be far more resilient than Republicans expected.


The target this time is a community outreach grant program that pays for "navigators" who can assist people in choosing plans on the healthcare exchanges that best fit their budget and family needs. The total amount available nationwide for such grants will be just $10 million, an enormous reduction from the $36 million available last year. And last year's grants were similarly chopped, from $63 million available in 2016, the last year the ACA was actually administered by people who thought Americans actually ought to have healthcare.

All this is on top of last year's 90 percent reduction in the advertising budget for the fall open enrollment period, shortening open enrollment from 90 to 45 days, plus multiple other steps HHS took to undermine the program. If last year is any indication, we should probably expect a steady stream of additional steps intended to further discourage people from signing up for insurance Donald Trump keeps declaring dead. It's hard to say how much any of those administrative actions will actually affect enrollment: Last year, despite Trump's efforts to kill the ACA, actual enrollment rates for 2018 were only 400,000 lower than the prior year, largely thanks to efforts by volunteers who support Obamacare, and to moves by blue states and insurance companies to increase outreach to potential signups. The constant Republican attempts to repeal the ACA probably kept the program on a lot of people's minds, too.

Just to add to the latest fuckery, the grants for healthcare navigators will also come with strings attached. In previous years, navigators helped people find plans on the exchanges, where all plans are required to provide complete coverage and to not punish people for having preexisting conditions. Starting this year, navigators are expected to also point enrollees to the shitty junk insurance plans the Trump administration has rolled out to undermine the insurance market. The guidelines released yesterday say applicants for grants will be

encouraged to demonstrate how they provide information to people who may be unaware of the range of available coverage options in addition to qualified health plans, such as association health plans, short-term, limited-duration insurance and health reimbursement arrangements

You know, the associations. We have associations. They're so much better! (They aren't!)

What's more, grant recipients will be urged to steer people to insurance agents and brokers, who may -- unlike navigators -- get a commission for selling junk insurance.

With open enrollment coming again in November, and with smart Democrats planning to make healthcare a major part of their midterm campaigns, we're tentatively hopeful people will have constant reminders about the need to sign up for insurance this year, just as they did last fall. Assuming the Trumpers don't require all ACA plans to be prepaid for a full year in cash, possibly in rubles, we're cautiously optimistic. But Jesus, what a petty little shit our "president" is.

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[Reuters / Fierce Healthcare / New York]

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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