San Antonio Express-News: Trump’s changes to health insurance sow confusion

After President Trump signed an executive order Thursday aimed at dismantling some parts of the Affordable Care Act, several organizations are working to enroll Texas residents in health insurance and hope to dispel confusion arising from the administration's announcement.

Trump plans to immediately halt federal payments for cost-sharing discounts, which reimburse insurers for lowering deductibles and co-pays for some customers. Additionally, Trump's executive order asks federal agencies to find ways to expand both the use of association health plans and what constitutes short-term insurance.

Short-term insurance is exempt from the Affordable Care Act. Association health plans are small businesses that join together to buy a health insurance plan.

Trump's executive order is a directive, not a law, and on Friday morning, he called on Congress to find a repeal-and-replace plan despite the new measures.

"The Democrats ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!" Trump tweeted.

Congressmen Joaquin Castro, D-San Antonio, and Lloyd Doggett, D-Austin, slammed Trump's order on health care.

"Texans will lose coverage and pay more for health care because of President Trump's recent moves to sabotage the insurance marketplace," Castro said in a statement.

Doggett criticized Trump for a soaring "insurance surcharge" and for his latest "one-two punch" that is "meant to knock out affordable health care."

"Like the Russians, who sought to sow chaos in last year's election, Trump, the master saboteur, by tweet and decree, is wreaking health care chaos," Doggett said.

Trump's announcements resulted in a haze of confusion for those seeking to enroll, starting Nov. 1, in the federal health care market and heightened the uncertainty that many insurance providers have felt since efforts to repeal the act began in the summer, though without success.

"It's just unconscionable that decision after decision would be made to make (insurance) less affordable and less accessible for people that need something so necessary," said Stacey Pogue, a senior policy analyst for the Center for Public Policy Priorities, a left-leaning think tank in Austin.

For many Texas residents, the questions are whether the Affordable Care Act is still in place and if financial help is still available.

Trump's cut to cost-sharing means that federal dollars will no longer pay for discounts to certain qualified customers and instead insurers will have to cover the cost entirely since they are required to under the act.

Some insurance carriers anticipated that Trump would eliminate the funding and subsequently prepared to raise premiums for 2018. The insurers that haven't increased premiums might do so now, given Trump's announcement.

Those who are enrolled in insurance and receive premium subsidies will be unaffected. Premium subsidies are separate from the cost-sharing discounts.

Those who earn too much to receive premium subsidies, specifically middle- to upper-income Americans, could get hit with higher premiums, Pogue said.

Of the 1.7 million Texans who get their insurance under the Affordable Care Act, half do not receive premium subsidies.

"That individual market insurance is facing a lot of uncertainty and instability because of the last 48 hours," Pogue said.

The consequences of Trump's directives are still unknown to policymakers and insurers. What will 2018 look like? Will subsidies still allow for health care to be affordable?

"I think there's a lot of confusion among consumers," Pogue said. "I don't know that is an accident. That might be part of the strategy around the timing of these decisions … to have a barrage of decisions that make it confusing over whether coverage is available, affordable."

In August, the administration cut 90 percent of the money for marketing and advertising used for outreach to help people understand and enroll in health insurance plans, Pogue said.

As a result, Cover Texas Now, a coalition of organizations for sustainable health care, is ramping up recruitment of volunteers and raising money to continue reaching out to Texans during open enrollment, which closes Dec. 15.

Indivisible 21, which was formed in opposition to Trump's election, has been tapping its networks to find volunteers to canvass areas statewide to help people sign up for health coverage. That effort is now even more important as many are left unsure of what Trump's announcements mean for their coverage, said Lisa Goodgame, the president of Indivisible 21 in Austin.

"I do find myself sort of standing in disbelief every day that these efforts to sabotage a program that has helped 20 million people get insured in the last several years," she said.