While the media and the country are being distracted by the daily crazy/sleazy coming from Washington, the Trump Administration is working feverishly behind the scenes to dismantle the rules: rules that protect us from dirty air and water, from discrimination in housing and education, and rules that guarantee us access to health care, among others.

The unremitting attack on the Affordable Care Act has been particularly effective. The GOP may not have been able to repeal it outright, but regulatory sabotage has been the next best tactic. Thanks to the administration’s actions–neutering and threatening to eliminate provisions of the ACA that were included in order to keep premiums affordable, health insurance rates continue to rise.

According to Larry Levitt at the nonpartisan, respected Kaiser Foundation,

New analysis: Insurers did very well in Q1 of 2018 in the individual market under the ACA. If not for looming repeal of the mandate penalty and expansion of loosely-regulated plans, we’d be looking at modest premium increases and even decreases for 2019. 

Evidently, however, the administration has decided that killing affordability by raising costs was too incremental; a recent article from The Washington Post reported on a much more direct attack.

The Trump administration took another major swipe at the Affordable Care Act, halting billions of dollars in annual payments required under the law to even out the cost to insurers whose customers need expensive medical services.

In a rare Saturday afternoon announcement, the Centers for Medicare and Medicaid Services said it will stop collecting and paying out money under the ACA’s “risk adjustment” program, drawing swift protest from the health insurance industry.

Risk adjustment is one of three methods built into the 2010 health-care law to help insulate insurance companies from the ACA requirement that they accept all customers for the first time — healthy and sick — without charging more to those who need substantial care.

As the article goes on to explain, two of the three methods were temporary;  risk adjustment, however, was to be permanent. Federal health officials are supposed to annually calculate which insurers had relatively low-cost consumers, and which had more expensive customers. Those with the lower-cost customers would make an adjustment payment to those whose customers were more costly.

This idea of pooling risk has had significant practical effects: encouraging insurers to participate in the insurance marketplaces the ACA created for Americans who cannot get affordable health benefits through a job.

In its announcement, CMS said that it is not going to make $10.4 billion in payments that are due to insurers in the fall for expenses incurred by insurers last year.

The announcement that payments due under the law would simply not be made is just the most recent measure taken by the Trump administration to demolish a law the GOP was unable to repeal legislatively. (It’s a tactic Trump is undoubtedly comfortable with–throughout his “successful” development career, he routinely stiffed architects, engineers and contractors. Wheelers and dealers who are willing to ignore the terms of contracts to which they are party are unlikely to have qualms about ignoring the obligations imposed by laws to which they are subject. But I digress.)

The administration has taken a number of steps to dismantle the ACA through executive powers.

Last year, health officials halved the length of the annual sign-up period for Americans to buy ACA health plans and also slashed by 90 percent the federal funds for advertising and other outreach efforts to urge people to enroll. Last October, the president ended another important subsidy to insurers: cost-sharing reduction payments, which cushioned them from the law’s requirement to provide discounts on deductibles and other out-of-pocket costs to low-income customers.

This year, the Department of Labor and HHS have worked to make it easier for people and small companies to buy two types of insurance policies that sidestep benefits required under the ACA and some of the law’s consumer protections.

There have been a couple of lawsuits in the lower courts over past calculations of these payments, with inconsistent results, and the administration blamed the withholding of funds on one of those decisions–a transparently trumped-up excuse. (Pun intended.)

“Risk adjustment is a mandatory program under federal law,” said Scott Serota, president of the Blue Cross Blue Shield Association. “Without a quick resolution . . . this action will significantly increase 2019 premiums for millions of individuals and small business owners. . . . It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most.”

Matt Eyles, president of America’s Health Insurance Plans, noted in a statement that the timing of this latest move could be particularly disruptive, because this is the season during which insurers around the country decide whether to take part in ACA marketplaces for 2019 and, if so, what rates to charge. “This decision . . . will create more market uncertainty and increase premiums for many health plans,” Eyles said.

Of course it will. That’s the whole intent.

And if thousands of people are bankrupted or die as a result? Too bad. They weren’t Republican donors anyway.


  1. I guess it will soon be time for a NEW administration, a NEW congress and Medicare for all.
    If we are not at war or something

  2. I guess I don’t understand. How can an agency refuse to follow a provision in a law? If the intent is just to invite legal action, knowing that the action will be rejected by the courts, but in a drawn-out manner, that suggests a degree of malevolence impressive even for Republicans.

  3. My son has Epilepsy, like 3 million other people in the United States. He has to take medication that is outrageously expensive even with insurance, with co-pays in the hundreds of dollars every month. In a year, he will no longer be eligible for coverage on my policy and as of now his seizure meds are not covered on the Indiana version of Medicaid. My son works part time despite having an average of 4 seizures per week just so he can pay for his medication. Any further dismantling of the ACA will make it impossible for him to stay alive; not just exist, but to survive. The same is true for anyone that has cancer, diabetes, auto-immune deficiencies, cerebral palsy, Parkinson’s, and the hundreds of other chronic diseases that require a lifetime of medical care.

    Anyone, absolutely anyone who supports Trump and the cruel, heartless politicians that support this destruction of the ACA should be held accountable for the misery and suffering they cause.

  4. “And if thousands of people are bankrupted or die as a result? Too bad. They weren’t Republican donors anyway.”

    We need to remember, Adolph Hitler committed SUICIDE. More than likely, Trump is also SUICIDAL, a SOCIOPATH suffering from Early Onset Schizophrenia. Ultimately, Republicans will suffer from this FIASCO, just like everyone else in the WORLD. They need to wake-up, before it is too late.

  5. Pat de Caprariis; being an attorney in Washington, D.C., or dealing with any issues coming out of Washington, D.C.; now is the time to be an attorney. Entire herds of attorneys are representing Trump alone on each of his individual legal issues. And some of those attorneys now need their own attorneys. Those who specialize in medical legal issues are being sought out now on both sides. I wonder if Republican Congress members, like Trump’s Republican supporters, are still not sure there is a difference between Obamacare and the ACA. Ignorance of the law is why people need attorneys; much of this is due to the lack of civics classes required in our schools – nationwide. Government classes teach the government process but offers no information regarding government failures to adhere to their own processes, including the Constitution and basic Rule of Law.

    Those opposed to Trump have herds of attorneys and herds of attorneys are defending those being charged by Robert Mueller’s investigation team of attorneys. When attorneys have attorneys the chances of loopholes, sabotage, crooks slipping through the cracks and going free and those who are innocent being unjustly convicted increases.

    “There have been a couple of lawsuits in the lower courts over past calculations of these payments, with inconsistent results, and the administration blamed the withholding of funds on one of those decisions–a transparently trumped-up excuse. (Pun intended.)”

    Where does the American public find their own herd of attorneys to Trump Trump’s ass – er, ace? Right now he is holding all aces on the ACA situation; it has just been pushed to the background by his daily court jester act. That case has never been out of the courts or inactive on any level; not even prior to Trump’s election and support of his private Congress except for the vote of one dying Republican Senator, John McCain. And we have to ask ourselves if that was personally motivated, coming after the surgery which led to his terminal brain cancer diagnosis.

    The proposed list of possible dropped Medicare coverages includes all of my health issues, most of which are basic issues with all elderly people, and I pay the full amount of the monthly premium, no sliding-scale consideration at the bottom of income levels. We are the once who cannot afford legal representation.

  6. Great article, Sheila. You give a perfect example for what action Brett Kavenaugh will take when somebody sues the government for not enforcing a law deemed constitutional. Kavenaugh has written that the President should be allowed to be “above the law” – that he be given license to override a constitutional law he doesn’t like by not enforcing it. Can we begin to fathom what disembowelment of the Constitution this would lead to?????

  7. Attorneys are not the answer. Were attorneys the answer to Adolph Hitler? The only answer lies with the PEOPLE. If they want to be a bunch of losers, then they will get what they deserve.

  8. I’m daydreaming of the dramatic effect of John McCain rallying for a serious issue in Congress being carried in on a stretcher and casting a deciding vote trumping Pence’s un-American tie-break by voting against the Republican rabid lockjaws. Bless him for leaving me with that image. It’s not likely to happen because we’re going to:
    OVERTURN CONGRESS ON NOVEMBER 6TH at your polling place.
    ERIC SWALWELL for POTUS in 2020.

  9. I guess the vulgarian and his cult of enablers misconstrued that whole “execute the laws” thing that his oath of office bound him to. And stiffing an industry for $10 billion? Guess where their campaign money is going to go to now.

  10. I have better insurance here in Switzerland. I pay about 500 a month, 500 a year deductible and they pay 90% and I pay 10%. I had blood work done last week and will get the results this coming week. My doctor asked me when I had my last pap smear or mammogram and both were over 8 yrs ago (because of the co-pay). She said, well, that’s covered on your insurance so we’ll get that done after your blood work results come in. She checked every and anything she could think of like iron, vitamin levels and of course, my thyroid since I have thyroid disease.

    I really believe the trumpers that HATE the ACA really don’t know what they are talking about. I think they are all traitors. It really is a life and death thing with the ACA and they just don’t get it.

  11. Teresa Kendall at 7:45am

    Teresa, I refuse to call it ACA and prefer OBAMACARE because politically we need to keep reminding ourselves and others that OBAMACARE is what the GOP keeps bitching about and keeps hacking away at. Of course it’s OBAMACARE by any other name is what we want to hold onto.
    I have no axe to grind; I get medical care from the VA, but I need to know when the GOP is effing around with YOUR medical care.
    Where are the babies? VOTE NO GOP IN 2018. ELECT ERIC SWALWELL for POTUS in 2020.

  12. Several comments yesterday and today, including Sheila’s post, discuss consequences. Mostly, the lack thereof.

    Correct me if I’m wrong, but the laws are written assuming morals would be in place first. In the business world, we call those ethics. A general sense of right and wrong.

    With just decisions, there are good consequences. With poor choices, there are negative consequences. The role of religion or the purpose of religion was to teach morals. When moral or good decisions aren’t made, we could appeal to the laws written for and by humans.


    This decision-making process is a very delicate balance, so what happens when there is no justice?

    Sociopaths who don’t have a conscience rise to power.


    They don’t suffer from a conscience. If I lie and cheat, I suffer from self-inflicted pains like guilt and remorse. I feel bad. I get no rest.

    Virginia and D.C. have the largest concentration of AA meetings in the world. Why do you think that is?

    My theory is all the folks who sold out their conscience for money make it to Washington. Those with a conscience suffer consequences and drinking numbs out those feelings of guilt and remorse.

    Sociopaths suffer no consequences for lying, cheating, and stealing.

    And who writes the laws and policies? Lawyers or lawmakers.

    As someone wrote yesterday if systems (games) are designed where lying and cheating are rewarded and being honest is a perceived weakness or detriment to the game, guess what?

    This evolution didn’t happen overnight. Jeffrey Sachs has made excellent observations about the people residing in Washington and CEO offices (sociopaths).

    When you construct a system which allows the dishonest behavior to be rewarded and honest behavior to be a weakness, guess what’s going to happen over time?

    Those who exclusively point to Trump are missing the forest because of a few trees. I believe Karl Marx, Vernon, and Marv have all pointed this out. Einstein pointed it out as well.

    Even Plato anticipated it with republics: “If voters don’t hold their government accountable, they will be ruled by their inferiors.”

    We crossed that line a very long time ago. Benjamin Franklin warned us to be diligent. Quite frankly, the Boomer generation failed us. The Millenials will have to clean up our mess if they can.

  13. My hope is that the increased cost of health insurance will push citizens and companies to demand single payer insurance that offers coverage to everyone. Single payer will take the burden off of businesses. It is long past time to eliminate tying health insurance to employment.

    When Pence managed to place Seema Verma at CMS I knew nothing good would come from that appointment. What many people are unaware of is that Pence fought tooth and nail against Medicaid expansion. His ALEC backers (Kochs) have always been against anyone but the extremely wealthy to have access to health insurance. Pence was backed into a corner by the Indiana hospital executives that warned him of closures if he refused Medicaid expansion. Hospital closures would have been a blow to his political career that he could not have overcome. He did not agree to the expansion because he cared about people who could not afford insurance. He only cared about himself…..and that is the basis of all of his decisions. Such a good Christian.

  14. Teresa @7:45a:
    and, Teresa, I ache for your frustrations with your son’s serious medical needs.
    See Aging Girl’s post at 8:35am. There’s an example of well organized protocol I’ll bet most of our citizens don’t get, maybe don’t even know about.
    All medical care SHOULD be managed with the Veterans Administration (VA) model, no credit to the Trumpists (except they don’t dare to mess with it) and no credit to the GOP who fought it all the way (probably on behalf of their rabid religionist co-conspiritors)

  15. im 63,i have a cpa do my taxes,im just working class,no home,no real estate,expecially,no wall street scams. after all,i drive a truck. i dont even make enough to get hit for not having signed up to the Aca.. i do however,watch the market. my wife had worked three diffrent jobs as a truckstop waitress,they all gave her some kind of plan to cover medical. we just never figured out what kind. she broke her wrist while riding her horse,seems that policy said she had to do it while in another country..(joking) actully,there was no coverage,period in that policy. same with the others. she got failed policy from her last job,when she called to verify,and see where she stood,seems all they cared about was acting like a used car salesman,and scam her into a diffrent policy,whereas,she pays alot more. actully,the jump from her company policy,which was free,would have costed her,about as much as the aca policy today. and did not,cover most issues with anycare besides out paitent.,and had holes in it big enough to float trumps likeness in englands demonstration through it.the company had a wierd name.something like banker indemity and health insurence,(dont quote me here,it was a wierd name)out of denver, seeems google had a whole page with discrediting issues of that scam. seriously,employers are,targeted by these companies,and though thier intentions are good,many are throwing money into a to on line scams,or phone scams,and nothing more.hense,the creation of the ACA..we have really sat back and allowed this to happen,and we,have done little of nothing,to call it like it is,fraud. we elect people to represent us,big deal. they reperesent little to notjing,but a hand shake to the scmammers.if,and any,elected official would change the ACA in any matter except to improve it,call em out publically,if your neighbor disagrees,tell them to go to hell. im looking at a massive protests in england,wheres our backbone America? obviously,we are sitting on a time bomb on more relivent issues in our time and we sounds like the kids in trumps lockup. we have the voting lists of the elected officials,target them,and do not stop.. reelection is a matter of money being thrown away,whereas,it could be used to stop this mess,and support the people who do the work,the largests voting block,and the ones sitting on thier ass, the working class..

  16. Popular Scottish comic Janey Godley, said: “I’m here to protest Trump because I think it’s important for women’s voices to be heard against someone who shows absolute disrespect for women. His policies are divisive and he has enabled racism and right wing opinion across Europe as well as in the US. The Americans who voted for him have every right to do so, but wait until they get sick and need healthcare.”
    A bit of history it was the Democratic Senator Max Baucus who refused to allow a seat at the table for Universal Healthcare or Single Payer, back when healthcare was being considered by the Obama Regime.

    That is factual history.

    So let’s move on. ACA -Obama Care was just a square wheel on the healthcare automobile. ACA had at it’s core the For Profit Health Care Industry. Thus, the need for subsidies.

    Forget ACA-Obama Care: Universal Health Care, Single Payer, or Enhanced Medicare for All, is the only way to go.

    The idea of saving ACA is a wasted effort. Some have decided to entrench behind ACA and defend it.
    “If you entrench yourself behind strong fortifications, you compel the enemy seek a solution elsewhere.”— Carl von Clausewitz.

    President Agent Orange and his lackeys are attacking what is left of ACA, they have followed the observation of Carl von Clausewitz and are seeking the solution, in this case attacking the subsidies.

    The Democrats need to Counter Attack with Universal Health Care, Single Payer, or Enhanced Medicare for All. At some point you have to go big, or throw in your cards and fold.

    H.R.676 – Expanded & Improved Medicare For All Act has 122 Co-Sponsors all Democrats. Nancy Pelosi’s name is absent from the list of Co-Sponsors. Health Care is a matter of life and death, but Pelosi has responded with profound indifference.

  17. Sabotage?… that isn’t the half of it. The man is being handled by Russia(.) and so are those in the Senate that are trying to dismantle this nation!!! I don’t know about the rest of you all, but I am beyond worry. I am at the planning stage. Planning how to survive the fall of this country. – Face it, I am stating plainly here: He will invite the Russians in the front door. Look he keeps all his meetings a ‘secret’ and he loves the ENEMY. So folks if you are stupid enough to sit there and just let it happen – you deserve what you will get. I ain’t goin’ to hell with you(.) Either stand up and shout – or get on your knees and beg! – but I am not a BEGGAR to a traitor or anyone! When tyranny is the rule – REVOLUTION IS THE ORDER. (And it begins with saying, “NO!” to Fascism!)

  18. I did not realize this but Indiana law requires that schools teach abstinence – only sex education. So birth control outside of “Just Say No” is forbidden. Birth control methods, and information on STD’s cannot be discussed, since abstinence implies no sexually activity.

    I suspect the bible thumpers fear teaching other than abstinence, would entail using Hustler Magazine or the Kama Sutra as text books.

  19. “And if thousands of people are bankrupted or die as a result? Too bad. They weren’t Republican donors anyway.”

    Speaking of which: The recent Pence/McCarthy orgy of fund-raising garnered almost a billion dollars from the usual suspects of organized bribery, aka the Republican party.


    I was required to teach abstinence only in Texas. The kids, bless their hearts, thanked me for my work (I taught them about STDs, birth control, etc.), but told me that this “program” was just more adult-to-child bullshit and that they were going to have sex when they wanted to.

    Yes, some Democrats voted against single-payer for the ACA. They are no longer in office. The Trump-ites are possessed by the psychological demons of Obama Derangement Syndrome. That disease drives their current agenda across the board. It is no longer any sort of secret that Republicans everywhere are fundamentally racist and their voters are racist bigots who are shit-scared of losing their white “dominance”. Any person of color you see at Republican rallies is completely around the bend and has NO idea what they’re doing.

  20. Vernon,

    “It is no longer any sort of secret that Republicans everywhere are fundamentally racist and their voters are racist bigots who are shit-scared of losing their white “dominance”. Any person of color you see at Republican rallies is completely around the bend and has NO idea what they’re doing.”

    I’m seeing this racist situation as a POSITIVE. Now we have a chance for a REAL democracy. By the time November rolls around, the two combatants will be easily recognized. The FASCIST FORCES dba the Republican Party, backed by the Koch led racist oligarchy, and the PRO-DEMOCRACY FORCES dba the Democratic Party.

    I’m betting on the PRO-DEMOCRACY FORCES prevailing. Our challenge, starting now with a clean slate, is for everyone voting to understand what is at stake in November.

    [dba=doing business as]

  21. I knew and predicted when McCain put the kibosh on outright repeal of the ACA that Trump and his minions would rule and reg the guts of ACA out of existence, and unfortunately, I was right. That is precisely what is going on. The answer is, of course, as it alway has been, to join the rest of the world’s democracies in having single payer coverage. We don’t need privatization of the nation’s health to make HMO CEOs and other health executives rich beyond belief – health is a right – and we don’t need to have insurance companies in charge of a right – that’s a public matter and should remain one irrespective of all the propaganda emanating from the right and rich who are desperate to maintain the status quo (along with their handmaiden Big Pharma).

    We have a lot of work to do when we regain power, not just in putting an end to public matters that have been privatized in reality, but in going the FDR route in instituting new programs that emphasize public control over the establishment and expansion of the public’s right to rule itself (e.g., reproductive health of women, health insurance for all, Big Pharma costs control, wage standards etc.). This fall’s election is about Trump’s pathology, to be sure, but it is more than that. It is also about reasserting the right of the public to control its own destiny as opposed to having it determined by a fascist dictator and his merry band of terminal capitalists.

    Parenthetically, I note that Bannon is in Europe while Trump is there, both of whom are involved in Bannon’s admittedly Leninist view of “deconstruction of the administrative state,” but this time in trumpeting the qualifications of May’s opponent for prime minister. Having successfully “deconstructed” the American administrative state, I suppose it’s time for Trump and Bannon to “deconstruct” the British and German states while giving aid and comfort to the dictatorship of Putin – and in broad daylight! Query – Have McConnell and Ryan joined the “deconstructionists?” Where are the sane?

  22. GOP Nazi

    By NATASHA KORECKI, Politico

    06/29/2018 08:14 PM EDT

    CHICAGO — Texas GOP Sen. Ted Cruz on Friday urged residents of a Chicago-area congressional district to vote for a Democrat if they must, to avoid giving even one vote to an avowed Nazi who won the GOP nomination.

    Cruz’s comments, made on Twitter, came after a POLITICO story detailed the Illinois Republican Party’s failed efforts to oust Holocaust denier Arthur Jones from the ballot or offer up an alternative for Republican voters.

    “This is horrific. An avowed Nazi running for Congress,” tweeted Cruz. “To the good people of Illinois, you have two reasonable choices: write in another candidate, or vote for the Democrat. This bigoted fool should receive ZERO votes.”

    Maybe Senator Cruz should be the new Democratic Party POSTER BOY.

  23. I picture the Orange Crush driving the world’s biggest bulldozer across the country pushing a mountain of bills into the future. All that he is undoing by just ignoring real problems of the real people who do the real work that pays everyone’s bills have, but Repubilcan donors don’t have, could fill an ocean that just can’t be crossed. The country will be Thug One’s most magnficent bankruptcy.

    What will Republicans claim about that bankruptcy? It’s a good thing that we started saving money by unregulating everything when we did or we wouldn’t have been prepared for this bankruptcy.

    By the standards of what’s coming 1929 was a a good year.

  24. It seems like everyone in the US feels freedom slipping from our grasp. Our differences are in how, what and who is causing it.

    Personally my imagination just cannot stretch to the place where the face on that isn’t Trump, Prince Pence, McConnell and Ryan all as puppets of the Kochs.

  25. I used to believe, mistakenly, that Trump’s most prominent neurosis was his narcissism. Instead, it is now clear, it is his cruelty, a form of sadism that Eric Hoffer explained comes from self-loathing. Hoffer said that “Passionate hatred can give meaning and purpose to an empty life.” In Trump’s case, however, self-loathing is not irrational. One could make a case that his whole reason for being is schadenfreude.

  26. Terry,

    “Instead, it is now clear, it is his cruelty, a form of sadism that Eric Hoffer explained comes from self-loathing. Hoffer said that “Passionate hatred can give meaning and purpose to an empty life.”

    In psychological or psychiatric terms it’s called TRANSFERENCE. Like you explained, “cruelty, a form of sadism….comes from self-loathing.” Hurting others, a country, or the world takes Trump’s mind away from himself. It makes him feel better.

    I recognized the danger Trump posed very early on, as he is very much like my biological father, who in his old age was, finally, diagnosed with Schizophrenia. Like Trump he manipulated himself into a powerful figure. At one time, he was probably the most powerful political force in North Florida, as Finance Chairman for the Democratic Party in Florida. With his financial and political power, it would have been almost impossible to have had him committed. Maybe that’s why they both want so much power; that’s one way to avoid a mental illness evaluation and possible commitment.

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