- Jay Bookman The Atlanta Journal-Constitution
Open enrollment for Obamacare coverage begins Nov. 1, and already experts are warning of trouble. After years of decline, the number of uninsured has begun to rise, and as many as 1.6 million additional Americans will drop out of the program in 2018, many because they will no longer be able to afford it, according to Wall Street analyst S&P Global.
The Trump administration deserves much of the blame — or in their own eyes, the credit. They have slashed the number of “navigators” hired to answer questions and help people through the enrollment process, they have slashed the number of hours that the federal website is functional, they have slashed the enrollment period itself in half, they have slashed the program’s outreach and advertising budget, and they have forced insurance companies to dramatically increase the rates they charge, with some companies abandoning the market altogether.
In short, they have used every administrative tool at their disposal to sabotage the program and to increase doubt among insurers and insured, and to some degree it appears to be working.
They have also continued to block every effort to fix the problem. Last month, for example, a group of Republican and Democratic senators hammered out a compromise that would address the rate-increase problem, and they claimed to have enough votes to pass it. However, President Trump quickly shot the plan down and House Speaker Paul Ryan said that if the Senate did pass it, he would refuse to allow his chamber to even vote on it. That ended that.
Shortly thereafter, Trump’s super PAC released a new TV ad, condemning Democrats for refusing to work with the president to fix health care.
Theoretically, you could try to defend such cynical sabotage if Republicans had a plan of their own that they wanted to implement. As we all have witnessed, they do not. They can destroy, but not build, and voters are noticing. In fact, with years of GOP health-care promises now exposed as fraudulent, Americans are increasingly likely to embrace Obamacare and to want it improved rather than destroyed. In the latest Fox News poll, 54 percent now say they have a favorable opinion of Obamacare, with just 42 percent unfavorable. That’s a 16-point improvement since March of 2015.
Unfortunately, the sabotage effort has been particularly successful here in Georgia, where Republican state officials have been trying to undermine the program since its inception. According to the Kaiser Family Foundation, only two states have a higher uninsured rate than Georgia, and health-insurance rates for individuals on the benchmark “silver plans” have risen an average of 48 percent this year, well above the national average.
Then there’s the rural health-care crisis, the opioid epidemic and the question of Medicaid expansion. Mortality rates in rural communities have risen significantly, which is astonishing in a modern industrialized country, and rural hospitals are being forced to close for want of customers able to pay for treatment. Those hospitals are a major economic driver in their own rights, and without them, communities also have little chance of attracting other employers.
As other states have discovered, Medicaid expansion could help break that cycle. By increasing the number of paying customers, it has kept rural hospitals open and saved precious jobs. It has also provided treatment to men and women addicted to opioids or methamphetamine. But the odds of Georgia Republicans approving expansion in the 2018 Legislature, with many in leadership facing primary challenges, look slim.