Guest Opinion: Lack of specifics will kill Obamacare

St. Louis Post-Dispatch
Jan. 30
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The first executive order that President Donald Trump signed after taking office Jan. 20 gave federal agencies broad powers to change, delay or waive provisions of the Affordable Care Act that regulators deem too costly or burdensome. The vague order was short on specifics. At first, it seemed like a gimmick aimed only at fulfilling Trump’s campaign pledge to start repealing Obamacare on his first day in office. But in its vagueness lies a major problem.

Trump has been all over the map on health care. He hates Obamacare but likes some of its provisions. He wants “something terrific” to replace it but won’t say what, though his replacement plan is “very much formulated down to the final strokes.”

He promises “insurance for everybody” at “lower numbers, much lower deductibles.” He doesn’t want a single-payer plan, but something new under which everyone will be “beautifully covered.”

Take that for what it’s worth, but the real clue about his intentions is the very uncertainty of his executive order. The health insurance market does not like uncertainty. If insurers can’t make accurate predictions about who’s going to be covered and how sick they’ll be, they will bail out of Obamacare’s individual markets.

If, as administration officials hinted, regulators ease the individual mandate requiring Americans to have health insurance or pay a big fine, or grant waivers to companies that say they can’t afford to cover their workers, fewer healthier people will be covered. Prices for those who need health insurance the most, older patients and those with chronic conditions, will become unaffordable. Merely by being vague, Trump’s order could tip the ACA into its much-feared “death spiral.”

During the presidential campaign, Trump himself noted this phenomenon: insurers bailing out of individual markets in some states because there weren’t enough healthy people in the risk pool to offset the sick people.

Premiums “are going up 35, 45, 55 percent,” Trump said in October 2015. “Their deductibles are so high nobody’s ever going to get to use it. So … Obamacare is turning out to be a bigger disaster than anybody thought.”

The executive order could accelerate the disaster. Add in congressional uncertainty over when and how to “repeal and replace” the ACA, the wonder is that any insurer would stick around.

Meanwhile, a new poll from Fox News finds that 50 percent of voters have a favorable opinion of the Affordable Care Act, up 9 percent from August 2015. Forty-six percent have an unfavorable opinion, down from 54 percent in the previous poll. We repeat: This was a Fox News poll, suggesting the kind of box that Republicans find themselves in.

Having lit the fuse on blowing up the ACA with his executive order, Trump is going to have to deliver that better, cheaper, more beautiful alternative. Quickly.