We Are Midway Through ACA’s 2020 Enrollment Period, But The Trump Administration Is Hoping You Won’t Notice

It has never been much of a secret that President Trump is not a fan of the Affordable Care Act (ACA), or Obamacare. Before he was sworn in, President Trump made a number of bold statements claiming he would repeal and replace ACA with a plan that would provide “insurance for everybody.” As history has shown, the GOP led legislatures attempts to repeal and replace ACA with what Democrats called a “skinny repeal” was famously thwarted by the late Senator John McCain shortly before his death. In leu of the swift killing blow that President Trump was hoping for (and which he is still working towards), it seems that he is now applying a death by a thousand cuts strategy to end the program and lower enrollment numbers. This strategy has played out in a number of ways in recent years.

Among other examples, the Trump administration nixed ACA’s individual mandate to purchase health insurance as of January 1 2019. The administration also adopted rules that allowed for the increase in the number of products outside of the regulated markets, known as “skinny plans,” which cost less, but have consumers paying more with notoriously high deductibles, lack consumer protections, and have muddied the waters of marketplace as consumers look for their best insurance option. Trump has also been supportive of work requirements that some states have worked to implement in their Medicaid coverage and that have frequently been blocked by the courts. Furthermore, various ongoing court cases against ACA, which the Trump Administration supports, have left many unsure if they can still get coverage in their state.

Indeed, these efforts seemed to have some effect on ACA enrollment within the federally facilitated marketplace in 2019, with a 4 percent decline. However, enrollment state by state stayed steady for the most part. Overall, despite President Trump’s assertions that ACA was “exploding” back in 2017, the marketplace has continued to expand and ACA has largely gained favor among the American public.

When it comes to ACA enrollment for the year 2020, Trump is employing three distinct tactics to undermine enrollment; shortening the period of enrollment, slashing funding for marketing enrollment, and cutting funds for ACA navigators. These steps now have states scrambling to pick up the slack.

The enrollment period for ACA 2020 this year was shortened from 3 months to only 6 weeks, terminating on December 15th. The ACA website states “If you don’t act by December 15, you can’t get 2020 coverage unless you qualify for a Special Enrollment Period.” This shortening of the enrollment period, coupled with the cuts to ACA marketing are likely a means to keep potential consumers unaware that the enrollment period is open at all. The Trump administration cut funding for ACA enrollment (including the navigator program) in 2018 by $26 million to just $10 million for organizations helping people enroll. This is compared to the $63 million that was budgeted in 2016.

The budget for ACA navigators (those who help consumers find the best plan for their needs and budget) was cut by 41% intermittently from state to state, with some state’s funding being cut very little while others have been hit hard. The Trump administration claimed that navigator programs who performed poorly were cut, but those who meet their goals for enrollment have maintained and will be able to keep their funding in the coming years. This has left many nonprofits and American cities to get creative in getting the word out, however reaching rural America remains a challenge.

The inevitable result of all of these cuts is that those who are living in the heart of Trump country (rural America), risk being left behind in 2020. Within the next few weeks it will become apparent just how effect (or perhaps ineffective) the Trump administration’s efforts to undermine ACA will have been.