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The “death by a thousand cuts” strategy

How To Kill A Health Insurance Market, Non-Legislative Division:

It’s constitutional – deal with it

The move by the White House to quietly end the contracts of two companies key to assisting people enrolling for insurance under the Affordable Care Act caught Houston health advocates off guard – but not by surprise.

Given the temperature in Washington these days and efforts by Congress and President Donald Trump’s administration to let the law fail, they said it was just the latest in a string of actions to sabotage the law known as Obamacare.

“It’s clearly by design,” said Elena Marks, president and CEO of Episcopal Health Foundation and proponent of the ACA and its impact on the uninsured and health access for Texans.

Last week, contracts for Cognosante LLC and CSRA Inc., which helped in signup efforts for the past four enrollment periods in 18 cities, including Houston, were not renewed for a final option year, the Associated Press reported.

[…]

Tiffany Hogue, policy director for Texas Organizing Project, an advocacy group for low- and moderate-income Texans, said she had not heard about the contract cancellations but felt, “in the scheme of things it’s not really a surprise.”

“The intent is to let the law die,” she said.

She said the administration from its first day has seemed determined to undercut the law. Hours after inauguration, the new president signed an executive order directing federal agencies to loosen any regulations surrounding the law that were considered “burdensome.”

Days later, as the 2017 enrollment period was coming to a close, the new U.S. Department of Health and Human Services withdrew funding for the final advertising push traditionally aimed to lure a surge of last-minute enrollees.

Additionally, the 2018 enrollment period is being shortened, cut in half to run from Nov. 1 to Dec. 15 instead of until Jan. 31.

The idea is to push enrollment down so that when it does go down you can point at it and say “look, see, it’s in a death spiral” and then take more obvious action to finish the job. Which may not be necessary now, but it’s Plan B as needed. And all those people who will be sicker and poorer as a result? Just a bit of collateral damage. I’m sure they’ll understand.

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