President Donald Trump and his administration have a message for uninsured Americans who fear the cost of treatment for COVID-19, the illness caused by the coronavirus: We don’t care.
On Tuesday, Politico reported that the federal government will not reopen health insurance enrollment on the federal HealthCare.gov exchange that serves the residents of 38 states. Peculiarly, those places are mostly GOP-leaning states that declined to create their own health insurance exchanges and that Trump won in the 2016 presidential election.
By contrast, the health insurance exchanges operated by California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, Washington state and the District of Columbia are allowing uninsured people to sign up for coverage and apply for financial assistance.
The negative consequences of this active refusal to offer help to vulnerable Americans are obvious.
The people living in the 38 states that use HealthCare.gov ― and those in Idaho, which hasn’t reactivated its state-run exchange ― will likely remain uninsured, leaving them potentially exposed to tens of thousands of dollars in costs if they get sick from the novel coronavirus and need medical treatment.
Moreover, the high cost of health care frequently discourages Americans from seeking care, especially those who are among the 28 million uninsured. And sick people not being isolated and treated means they are at risk of spreading the coronavirus to more people.
No one benefits from not allowing these millions of Americans to get health coverage in the midst of a pandemic that has practically shut down the nation. There is no upside to the Trump administration’s decision.
It is plain, as it has been during Trump’s entire presidency, that he is utterly unconcerned about people in need. It is just as plain that this cruel and spiteful move is rooted at least in part in Trump’s obsession with tearing down anything his predecessor Barack Obama did.
The Affordable Care Act, which created the exchanges, anticipated a moment like this. Even in the states where people can’t enroll because of the Trump administration and the Idaho government, they still can qualify for health insurance and income-based subsidies under certain circumstances, such as losing a job. The law allows for “special enrollment periods” for emergencies, which is why 11 states and the District of Columbia have taken advantage of the option.
Newly jobless people also may be eligible for Medicaid coverage, which is cost-free in most cases.
More than 100 House Democrats pleaded with Health and Human Services Secretary Alex Azar for a special enrollment period for the coronavirus outbreak in a letter, as did nine Senate Democrats in a letter to Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Chuck Schumer (D-N.Y.).
So did more than 200 patient advocacy organizations, labor unions and nonprofits in a letter to Vice President Mike Pence, Centers for Medicare and Medicaid Services Administrator Seema Verma and Azar. Rep. Lloyd Doggett (D-Texas) and Sen. Bob Casey (D-Penn.) authored legislation to force a special enrollment period, but it has not advanced.
But for Trump and other Republicans, using the Affordable Care Act to offer assistance during an emergency would be an admission that the law and its benefits help people. An admission of that sort would blow up the decade-long Republican mantra that “Obamacare” is nothing but a train wreck destroying the American health care system.
It was only days ago that Trump affirmed that he continues to support a lawsuit pending at the Supreme Court that would eliminate the Affordable Care Act. “What we want to do is terminate it,” he said on March 22. (The Republican state attorneys general who originated the lawsuit also aren’t backing down.)
Perhaps it’s not surprising that Trump’s hostility toward the Affordable Care Act ― arguably Obama’s most impactful domestic policy initiative ― wouldn’t abate, even during a global public health emergency.
Prior to running for president, Trump railed against Obamacare. He promised to repeal it on the campaign trail four years ago. He spent much of his first year and a half in office on a failed effort to repeal the law in Congress. He joined the lawsuit awaiting a hearing at the Supreme Court.
But the harms that would befall the estimated 20 million people who would become uninsured if that lawsuit succeeds remain abstract. What’s very real is that a growing number of Americans are getting sick from a disease with no cure and are staring down life-destroying medical bills, and Trump has decided the right thing to do about that is nothing.
The deadlines to enroll in state-based health insurance exchanges are: