Confronted with the rising popularity of the Affordable Care Act, the White House, Congress and Republican governors are grappling with disparate strategies to repeal, replace or repair it. The confusion is increasingly disruptive to the individual insurance business, which has come to rely on Obamacare subsidies and rules. During this period of uncertainty, the Trump administration needs to ensure there’s a working system in place when future policy is finally decided.
Tom Price, the recently confirmed secretary of Health and Human Services, seems to recognize the need and has suggested new rules meant to stabilize the market. Unfortunately, his proposals are inadequate to the challenge.
Price would shorten the ACA’s annual open enrollment period to one and a half months, from three, as insurance companies have requested, to minimize the number of people who wait until they get sick to sign up. And he would require more documentation from people who are eligible to buy insurance during special enrollment periods (when they’ve changed their marital status, for example).
It’s not clear, however, how much these changes will strengthen the market. That’s because stricter requirements and shorter enrollment periods don’t address one of the law’s main weaknesses — not that too many sick people sign up, but that too few healthy people do.
A more effective strategy would be reinforce, for now, the Obamacare pillars that shore up the private insurance market: the individual mandate, and the cost-sharing and reinsurance payments to insurance companies.
The mandate, the requirement that all Americans either have health insurance or pay a tax penalty, hasn’t worked as well as intended, largely because the penalty is too weak. Although the Trump administration is unlikely to want to strengthen the penalty, it should at least make every effort to enforce the law as it stands — until some other incentive can be devised to keep young and healthy people insured. But the Internal Revenue Service, acting in response to an executive order, has recently backed off efforts to stiffen enforcement of the mandate.
It’s entirely understandable that Trump failed to deliver anything special Tuesday night — this issue is complicated, as a wise man once said — and the president and Congress shouldn’t feel obligated to sort out the future of U.S. health care in the space of a few months. But while they do, it’s important to keep the existing system from weakening any further.