As I watch the debate unfold over repeal of the Affordable Care Act, I keep thinking about the Hans Christian Anderson story "The Emperor's New Clothes." In the story, the emperor's weavers convince him that they have made him clothes of special cloth, invisible to those too stupid to appreciate their beauty. The emperor parades through town stark naked, and his subjects are too afraid to state the obvious until one little boy blurts out that the emperor has no clothes. The emperor looks down and realizes the boy is right.
You might guess that President Donald Trump is the emperor in my metaphor, but you'd be wrong. The emperor is the American public, who has been duped into believing that the Affordable Care Act is failing, even as Republicans work behind the scenes to destroy it.
And who is the little boy in this story? I am. I am the former CEO of a health insurance company, and I have been warning publicly what will happen if Trump continues to effectively sabotage the Affordable Care Act. Earlier this month, I lost my job.
When Trump ran for president, he promised reforms to ensure there would be health insurance for everyone and that it would be a "lot less expensive" than under President Barack Obama's health care law. We have yet to see the plan he described during his campaign. Instead, earlier this month, House Republicans passed the American Health Care Act – a bill the nonpartisan Congressional Budget Office determined would cause 23 million Americans to lose health insurance coverage.
When confronted with the dire projections about how their bill will make insurance unaffordable for their constituents, most of the representatives who voted for the bill often echo a line that Republican House Speaker Paul Ryan, Secretary of Health and Human Services Tom Price and Trump have used repeatedly: that the Affordable Care Act is in a so-called "death spiral" that will inevitably "explode," so they need to pass a bill, no matter how terrible, before it does. That narrative is patently false. In fact, most of the instability driving up premiums in the marketplace can be directly traced to Republicans' efforts to undermine the health care law for their own political purposes.
Florida Republican Sen. Marco Rubio, for example, was among the first to land a blow. In 2014, he proudly led a successful effort to cut funding for the "risk corridors" program. Rubio called the payments made from these funds a "bailout" for insurers, but in fact the program was an integral backstop to help control premiums as insurance companies in the marketplaces adjusted to the new population they were covering. The consequence of that ploy to score political points was that some insurers left the marketplace, and many Americans' premiums went up.
Since Trump took office in January, these kinds of sneak attacks on the law have accelerated. During the final week of the open enrollment period, when consumers can sign up for a marketplace health care plan or choose a new one, Trump officials within the Department of Health and Human Services decided to cancel advertising and outreach for the HealthCare.gov website. That decision came despite the fact that it is well documented that younger, healthier enrollees tend to sign up at the last minute. It was a transparent effort to damage the stability of the health insurance marketplace and to create the illusion that demand for insurance was decreasing.
Perhaps the most drastic way that the Trump administration is sabotaging American's health insurance is by refusing to commit to reimbursing health plans for the cost-sharing reduction payments they make to lower out-of-pocket costs for their lowest income members. Insurance companies are currently in the process of determining their rates for the 2018 plan year, and without a guarantee from the administration that they will receive the payments they are owed, they will factor that added cost into their premiums for next year. And you don't have to take my word for it – the Kaiser Family Foundation estimates that insurers would need to raise premiums for silver-level plans by an average of 19 percent to compensate if the administration will not commit to making the cost-sharing reduction payments.
One common thread in all these efforts is that Americans who purchase their health coverage through the individual market are the ones harmed, not insurance companies. The administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don't let them fool you.
If you think Obamacare is failing, I have one simple message for you: Open your eyes and stop being the emperor.