Obamacare is in a total death spiral my
name is Jerry weed and from 2010 to 2012
I was the assistant secretary for
planning and evaluation at the
Department of Health and Human Services
in the Obama administration when you
think about whether Obamacare is
collapsing I think you really have to
sort of think about the current
situation and the counterfactual would
it naturally collapse or is it
collapsing in part because the
administration is causing it to collapse
premiums last year that is coming into
this year cycle increased quite a lot
there are a couple of things
administration has done that may be
contributing to weak performance of the
exchanges the first thing is that when
almost the first thing that trump the
president Trump did when he entered
office is to put out an executive order
saying that they would not be
strenuously enforcing the individual
mandate so that likely led to some
reduction in signup they also turned off
the marketing they get a little bit
earlier this year than had been done in
prior years but the most important
concern I think in terms of disability
and future of these markets is that they
are supposed to have a stream of money
come in to pay for reductions in a cost
sharing below income subscribers so the
way that the Affordable Care Act is set
up if you're a low-income person and you
buy a health plan that health plan gets
an extra subsidy so that your
deductibles your cost-sharing what you
have to pay when you go to the doctor
isn't too high there's been an argument
between the Republican Congress and
President Obama when he was still in
office about whether the money that was
flowing under that piece of the
legislation had correctly followed
congressional rules but President Trump
has not been clear about whether he will
let those payments flow or not if the
payments don't flow insurers will be
responsible for reducing for giving
better coverage to low-income people but
they won't be subsidized for that and
they're building that into their
premiums and raising them accordingly
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