Throughout his presidential campaign, Donald Trump repeatedly vowed to swiftly "repeal and replace Obamacare." But despite a GOP-controlled House and Senate, all efforts to strike down Obamacare have failed.
After the Senate rejected the "skinny" Affordable Care Act repeal in July, Trump declared that his new plan is to "let Obamacare fail" on its own. "We're not going to own it. I'm not going to own it," he said. "I can tell you the Republicans are not going to own it. We'll let Obamacare fail and then the Democrats are going to come to us."
Although "letting it fail" implies a passive approach, the Trump administration is making efforts to ensure that it won't succeed.
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Affirming its disdain for "Obamacare," the administration on Thursday announced sharp cuts in programs promoting health care enrollment under the Affordable Care Act for next year.
Advertising will be cut from $100 million spent on 2017 sign-ups to $10 million, said Health and Human Services officials.
Funding for consumer helpers called "navigators" will also be cut about 40 percent, from $62.5 million for 2017, to $36.8 million for next year. That change reflects a new performance-based ethic that penalizes navigator programs failing to meet their sign-up targets, administration officials said.
About 12.2 million people signed up for subsidized private health insurance under Barack Obama's signature law this year, many in states that President Donald Trump carried in November. Current enrollment is estimated to be around 10 million, due to attrition also seen in prior years.
Top Democrats accused the administration of malice.
House Minority Leader Nancy Pelosi of California said the administration is waging a "cynical effort to lower enrollment" that would "create chaos" and increase premiums.
Her Senate counterpart, Chuck Schumer of New York, said the administration "is deliberately attempting to sabotage our health care system," adding that "the American people will know who's to blame."
It was unclear how Trump's latest move might affect a planned effort in the Senate to craft bipartisan legislation that would stabilize insurance markets.
Trump and congressional Republicans have been unable to deliver on their vow to "repeal and replace" the 2010 health care law, but the president has repeatedly pronounced the program on the verge of collapse.
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On Twitter and in interviews, Trump has threatened to give "Obamacare" a nudge by cutting off payments to insurers that help reduce consumers' copays and deductibles. Still, his administration has continued making payments month to month.
Independent observers say the ACA's insurance markets have problems, but are not about to implode. For next year all U.S. counties will have at least one participating insurer, although consumers in close to half of counties will only have a single carrier serving them. Some major insurers have left the program after taking deep financial losses.
HHS officials announced the promotional cutbacks in a conference call with reporters. The three officials who described the details of the cuts refused to be identified by name.
The administration says the government hasn't gotten much bang for its buck as far as ACA advertising and the navigator program, with some enrollment centers signing up very few customers.
By comparison, HHS said the combined advertising budget for Medicare Advantage and Medicare prescription drug plans is $9.7 million.
HHS officials said the 98 navigator programs funded by the ACA enrolled fewer than 82,000 people, or less than 1 percent of the total. Navigator staffers are supposed to guide consumers through the sometimes complicated enrollment process, which involves estimating income for the coming year, proving citizenship or legal residence, and sorting through various health plan options.
For next year, officials said navigator funding will reflect each sign-up center's prior performance. For example, if a navigator program met 70 percent of its enrollment target, it will get 70 percent of its previous funding. If it only enrolled 30 percent, its funding will be cut to 30 percent. However, every center will get some money from the government, even if it's only a few thousand dollars.
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"Judging effectiveness by the amount of money spent, and not the results achieved, is irresponsible and unhelpful to the American people," HHS spokeswoman Caitlin Oakley said in a statement. "During the upcoming enrollment period, navigators will be funded in proportion to their performance."
HHS said only 1 in 5 navigators met their own performance goals. Officials said 17 programs enrolled fewer than 100 people each, although they did not identify whether those programs were in urban areas or less populated rural zones. One program got $200,000 and signed up one person, HHS said.
Adding to sign-up challenges, the ACA enrollment season will be considerably shorter for 2018, running from Nov. 1-Dec. 15.
Soon after taking office, the Trump administration pulled back some advertising for the 2017 sign-up season, angering Democrats, who requested an investigation by the HHS inspector general. That probe has not yet been completed.
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