Trump finds new ways to make the sick pay more

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President Donald Trump has announced some new strategies to destabilize the individual health-insurance market, but his misguided objective is the same as ever: to undermine the Affordable Care Act and, more broadly, the very idea of health insurance.

His latest executive order, signed Thursday, will cause premiums to fall drastically for "millions of Americans," Trump said. What he didn't mention is that these potential savings would accrue only to people healthy enough to gamble on skimpy insurance coverage. Sicker people, left stranded in a deteriorating risk pool, would see their premiums rise.

In other words: The changes would shift costs, not save money, for the health-care system.

Trump has ordered his cabinet to arrange for more small businesses to join in "association health plans" that are exempt from the rules of the Affordable Care Act. And he plans to allow people to remain on short-term insurance policies (also exempt) for as long as a year. Such plans could charge higher premiums for people with preexisting health problems. These people, who have greater-than-average need for essential health benefits like hospitalization and mental health care, could instead remain in the protected Obamacare marketplace. But with fewer healthy people paying into that system, the premiums for everyone left would rise.

This is the very problem that Obamacare was created to solve. Under the Affordable Care Act, the premiums paid by healthy people help subsidize the more expensive care needed by sicker people (the same thing happens in employer-provided health insurance). In return, the healthy have the security of knowing that, if the need arises, they too will be taken care of.

Trump wants to dismantle this cooperative arrangement and just let healthy people buy cheaper policies. What happens to the sick under this system — and the healthy, for that matter, when they unexpectedly become sick — Trump did not say.

Americans are increasingly inclined to see health care as a collective responsibility. Six in 10 Americans now think it's the federal government's duty.

Trump has found other ways to remove healthy people from Obamacare risk pools. His administration is refusing to help people sign up for policies during the fall enrollment period. And he's dropped many hints that he might soon decline to enforce the ACA mandate that every American have insurance.

Trump's latest executive order, like his previous moves, seems motivated more by frustration at Congress's inability to repeal Obamacare than by any concern for the smooth functioning of the individual health-insurance market. Regardless, it puts the health of millions of Americans at risk.



— Bloomberg View


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