obamacare affordable care act
Credit: iStock

The Republicans failed to repeal Obamacare legislatively. That doesn’t mean they’ve given up trying. In a tweet storm today, Andy Slavitt, who was the Acting Administrator of the Centers for Medicare and Medicaid Services during the Obama administration, says that they are now attempting a “synthetic repeal.” This one won’t be scored by CBO and has tossed aside any attempt to replace the law. That means that the results could be even more disastrous for the American people.

Slavitt identifies three tools Republicans are using to achieve synthetic repeal:

  1. An executive order coming next week
  2. The budget/tax plan
  3. Sabotage of the ACA

The executive order Trump plans to sign is being sold as the fulfillment of his promise to allow insurers to sell plans across state lines. But here’s the catch:

The basic idea is that insurers would be able to sell policies in multiple states but only have to adhere to the regulations of their home state. So an insurer from a lightly regulated state, where policies may offer skimpier benefits and lower premiums, could start marketing its plans in a highly regulated state, where premiums tend to be higher…

…it would split the market so that healthier folks would flock to the skinnier plans, while the sick would stay in the more comprehensive plans, pushing up their rates even more.

As Slavitt points out, bypassing Obamacare regulations means that these plans would provide no protections for those with pre-existing conditions and so would basically turn the Obamacare exchanges into high-risk pools, which are financially unsustainable.

As the repeal/replace plans were developed in Congress, it was often noted that their significance was that they were an attempt to gut Medicaid and provide the opening salvo for the tax cuts Republicans were intent on giving to the wealthy. As we’ve now seen with the Republican budget/tax cut plans, those efforts have continued, with proposed cuts of at least $1 trillion to Medicaid as well as reductions to the Obamacare subsidies. Here is how someone summed that up to Slavitt:

We’ve been talking about the Trump administration’s efforts to sabotage Obamacare for a while now. They have cut the open enrollment period by more than half and all but eliminated outreach/assistance. Juliet Elperin brings us another example of their sabotage methods.

For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application.

Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.

Supporters of the Affordable Care Act see the president’s opposition even to changes sought by conservative states as part of a broader campaign by his administration to undermine the 2010 health-care law. In addition to trying to cut funding for the ACA, the Trump administration also is hampering state efforts to control premiums. In the case of Iowa, that involved a highly unusual intervention by the president himself.

Each one of these three synthetic repeal tools is an outrageous dereliction of the administration’s responsibility to “faithfully execute the laws of the land.” Here is how Slavitt sums up the combination of the three:

Legislative attempts to repeal Obamacare were beaten back because the public knew what was happening and stood up to object. The danger of synthetic repeal is that it is happening behind the scenes and out of the spotlight… unless we get the word out.

Nancy LeTourneau

Follow Nancy on Twitter @Smartypants60.