Associated Press August 23, 2018
WASHINGTON (AP)
— A congressional watchdog said the Trump administration needs to step up its
management of sign-up for former President Barack Obama's health care
law after mixed results last year in the throes of a
failed GOP effort to repeal it.
The report due out
Thursday from the Government Accountability Office is likely to add
to Democrats' election-year narrative that the administration
actively undermined "Obamacare" without regard for the consequences
to consumers.
The nonpartisan
Government Accountability Office was more nuanced. On one hand, it found
problems with consumer counseling and advertising and recommended such basic
fixes as setting enrollment targets. But it also credited administration
actions that did help people enroll, such as a more reliable HealthCare.gov website
and reduced call center wait times.
Sign-ups for 2019
begin this November.
A copy of the
report from the investigative agency for Congress was provided to The
Associated Press.
It found that:
— The Health
and Human Services Department under Trump broke with its own previous
practice by failing to set enrollment targets for HealthCare.govlast
year. The watchdog recommended that HHS resume setting goals, a standard
management tool for government agencies. Without setting numeric goals, HHS
won't be able to measure whether it is meeting "its current objective of
improving Americans' access to health care," the report said. The
administration responded that it does not believe such targets are relevant.
— HHS used
"problematic" and "unreliable" data to justify a 40 percent
cut in funding for enrollment counseling programs known as Navigators. HHS
responded that it's making changes to how those counseling programs are
evaluated. But it has cut funding again, by about 70 percent.
— When HHS slashed
money for open-enrollment advertising by 90 percent overall, officials said
they were doing away with wasteful spending. But an internal study by the
department had actually found paid television ads were one of the most
effective ways to enroll consumers. The budget for TV ads went from $26.6
million in the Obama administration's final year to zero under
President Donald Trump.
"This
independent and nonpartisan GAO report confirms that the Trump administration's
sabotage of our health care system is driving up costs for consumers and
leaving more Americans without health insurance," said a statement from a
group of Democratic lawmakers led by Rep. Frank Pallone of New
Jersey.
HHS said in a
statement that the 2018 enrollment season was the "most cost-effective and
successful experience" for consumers, citing a 90 percent customer
satisfaction rate with the HealthCare.gov call center.
Republicans' drive
to "repeal and replace" the health care law stalled in
the Senate last year, and the Trump administration instead found
itself having to run a program the president repeatedly branded a
"disaster."
The watchdog found
that sign-ups in the 39 states served by HHS through the federal HealthCare.gov website
dipped by 5 percent last year, while states running their own enrollment effort
maintained their sign-up levels. A total of 11.7 million people enrolled for
2018 coverage, with about 85 percent receiving subsidies to help pay their
premiums.
The report
validated a longtime Republican criticism that high premiums discourage
consumers from signing up for coverage. But it also found that Trump contributed
to premium increases for 2018 by canceling payments that reimburse insurers for
lower deductibles and copays provided to low-income people. That forced the
carriers to jack up rates.
"Substantial
increases" in premiums triggered by Trump cut both ways, the watchdog
found. People with modest incomes entitled to subsidies got more financial aid
from the government, and their coverage became more affordable. But solid
middle-class customers paying full premiums were priced out of the market.
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