Editor's Corner—When federal health officials put politics over policy, everyone loses

Seema Verma swearing in
Centers for Medicare & Medicaid Services Administrator Seema Verma is in charge of administering the Affordable Care Act, but she and HHS Secretary Tom Price have been putting more energy into proving why the law is failing. (Office of the Vice President)
headshot of Leslie Small
Leslie Small
Republicans are getting a lot of flak for how little they're saying about Senate’s healthcare overhaul bill, but what the Trump administration is saying about the Affordable Care Act is even more troubling.

In fact, federal health officials have been spending an awful lot of energy attacking the ACA when they're supposed to be dutifully administering it.

When a new administration took the reins of the Centers for Medicare & Medicaid Services and the Department of Health and Human Services, the agencies' new stance on the law quickly became clear. For example, one of CMS’ biweekly enrollment snapshots in February started off with a routine update of marketplace plan enrollment figures, but then sneaked this in:

“Those selections were made from a market that experienced a 25% increase over the previous year in the average premium for the benchmark second-lowest cost silver plan as well as a 28% decline in the number of issuers participating over the past year.”

Those numbers weren’t new, but they were a harbinger of what was to come from both health agencies. For example:

  • When CMS announced its final market stabilization rule aimed at patching up the ACA exchanges, it included this quote attributed to Verma: “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”
  • And in May, when the Congressional Budget Office—which is, in fact, nonpartisan—scored the American Health Care Act, HHS Secretary Tom Price had this to say: “The CBO was wrong when they analyzed Obamacare’s effect on cost and coverage, and they are wrong again.”

Of course, during the Obama administration, HHS and CMS news releases often included a “hooray for the ACA”-type quote from health officials, and the agencies did their utmost to minimize any news that might reflect poorly on the law.

But the Trump administration-controlled CMS kicked it up a notch last week with two reports aimed at pointing out what a failure the ACA is, not just mentioning it in passing. The first came with a headline-ready announcement that nearly 2 million people failed to pay their first month’s premium after signing up for ACA exchange plans for 2017.

However, that level of attrition isn’t much different than it was last year—though it’s kind of hard to tell, because the report covered only through mid-March, not through the end of March as CMS usually did under the Obama administration. CMS did say, though, that it will update its numbers.

The second report—which used exit survey data to delve into why people dropped their exchange coverage—is admittedly informative, especially since I don’t recall the Obama administration ever releasing an examination of such a topic. The news release summing up both reports, though, only highlighted the fact that cost was the most-cited reason for consumers leaving the exchanges, since that is the finding that most serves the "ACA is terrible" narrative.

Such evidence of obvious bias is disappointing coming from agencies that are supposed to serve the public good, not a particular political agenda. It shouldn’t be too much to ask that they provide accurate, unbiased communications in their administration of the ACA, which is still the law of the land.

From rhetoric to action

What's even more concerning is that health officials are pairing their anti-ACA rhetoric with actions like halting open enrollment advertising, or in Verma’s case, suggesting in a meeting with insurers that the administration might consider funding cost-sharing reduction payments only if they supported the GOP’s healthcare bill.

In case you were wondering whether these actions have consequences, a pair of analyses last week from the consulting firm Oliver Wyman detailed how uncertainty about the ACA’s fate is driving insurers to request sky-high rate increases for 2018 and consider exiting the marketplaces completely. 

In fact, two Democratic senators have asked the HHS Inspector General to investigate “the extent to which the administration's actions have increased uncertainty, increased insurance costs for individuals or the government, reduced individuals' insurance choices in some parts of the country, increased the number of uninsured, or otherwise undermined the goals, implementation and enforcement of the Affordable Care Act.”

Granted, there is surely political motivation behind the senators’ request, but looking at both the statements and actions of federal health officials in recent months, it’s hard to argue against their point.

The real question is, if Republicans fail in their years-long quest to repeal the ACA, how far will this administration go to erode a law that it is still charged with upholding? And more importantly, how many people will be harmed in the process?

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