If he can’t kill it by vote, maybe he can starve it to death.

That seems to be Donald Trump’s intensified approach to the repeal-replace efforts on the Affordable Care Act, with BuzzFeed reporting that the Department of Health and Human Services will not be sending any regional directors to help states with planning for the upcoming open enrollment period this year.

According to the report, this is the first time that regional directors won’t be assisting states. Mississippi’s health care advocates found out via an e-mail on Monday, confirming news from a BuzzFeed source that “all of the department’s 10 regional directors were told to not to participate in state-based events promoting open enrollment.”

The e-mail confirmed news first reported by Vox that officials would be absent from Mississippi events, as well as informing advocates that the department would “not be supporting marketplace efforts by being out in the regions this year.”

In a Wednesday statement, the report adds, department press secretary Caitlin Oakley said, “Marketplace enrollment events are organized and implemented by outside groups with their own agendas, not HHS. These events may continue regardless of HHS participation.” Oakley’s statement adds that, “As Obamacare continues to collapse, HHS is carefully evaluating how we can best serve the American people who continue to be harmed by Obamacare’s failures.”

But any collapse appears engineered by the Trump administration after repeated declarations by the president that he would “let Obamacare implode.” And this isn’t the first action the administration has taken to steer the ACA toward that goal, nor will it be the last—actions that some are outright calling sabotage.

Not only did HHS announce in August that it was cutting its Obamacare enrollment advertising budget by 90 percent, from $100 million down to $10 million, but it’s also decided to shut down healthcare.gov every Sunday from 12 a.m. to 12 p.m. throughout the open enrollment period—something else that’s far above the norm of past enrollment periods. And that’s after already cutting the enrollment period in half compared to earlier years, thus giving people far less time to sign up.

Trump has also refused to say that he will definitely authorize payment of the subsidies that enable the system to function for the poorest and sickest—an action that’s driving up premiums as nervous insurers try to anticipate how much they might be on the hook for if those subsidies aren’t paid.

But wait, as the commercials say, there’s more—some of which comes from Trump’s love of executive orders. Not only did he sign an executive order on his first day in office directing agencies to delay or waive provisions of Obamacare that would “impose a fiscal burden,” but the latest news, courtesy of a Huffington Post report is that he’s planning to sign another one—this time on associations.

Executive action on association health plans, the report points out, could end up exempting association health plans from some of the ACA rules—those pesky things that made it possible for so many people to get broad health insurance coverage under the new law despite preexisting conditions and other former barriers.

Says the report, “[A]ssociation health plans, also known as AHPs, might have more freedom to sell skimpier plans that, for healthier beneficiaries, would be cheaper than plans they are buying todayeither through HealthCare.gov or state-based exchanges, or directly from insurers. But the more healthy people flocked to those plans, as individuals or part of small businesses, the more carriers selling to everybody else would have to increase their premiums to reflect their new, sicker pool of enrollees.”

“We don’t know exactly what the Trump administration is going to do on this front,” Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms, says in the report. “But if they allow AHPs to bypass the ACA’s consumer protections, like not covering maternity and other essential health benefits, it sets up an uneven playing field, destabilizes the state individual and small group markets, and ultimately puts consumers at risk.”

Instant Insights /

Trump administration pulls regional directors from open-enrollment events

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