美国国家公共电台 NPR Trump Is Trying Hard To Thwart Obamacare. How's That Going?（在线收听）

AUDIE CORNISH, HOST:

Despite President Trump's pledges to dismantle the Affordable Care Act piece by piece, those insurance marketplaces are still up and running, and open enrollment is just a few weeks away. Here to talk us through the changes to the law under the Trump administration is NPR's health policy reporter Selena Simmons-Duffin.

Welcome back to the studio.

SELENA SIMMONS-DUFFIN, BYLINE: Hi.

CORNISH: The big one is definitely the individual mandate, right?

SIMMONS-DUFFIN: Yes.

CORNISH: That's where the focus has been. And the penalty for not having insurance right now is zero. Here's what the president said earlier this month at an event in Florida.

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PRESIDENT DONALD TRUMP: We eliminated Obamacare's horrible, horrible, very expensive and very unfair, unpopular individual mandate - a total disaster.

CORNISH: Selena, what's the impact of that, then?

SIMMONS-DUFFIN: Well, the reason for the mandate was to get healthy people into the market. So with it gone, do healthy people get their coverage elsewhere? This is the first year the penalty is actually zero, but insurers have anticipated the Trump administration wasn't going to enforce this. So premiums have risen a bit, but it hasn't been so astronomical that a lot of people have fled from the market.

But the big impact has been in the courts. Because the penalty is now zero, there's a new avenue for people attacking the ACA to attack it again. And there's a ruling expected from the 5th Circuit Court of Appeals any day now, and it's probably headed to the Supreme Court. So that would be the third case on the Affordable Care Act before the Supreme Court.

CORNISH: Another way the president has tried to weaken the ACA is with cheaper so-called skinny health plans. Here he is again at that event in Florida.

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TRUMP: We vastly expanded affordable insurance options, including association health plans, short-term plans and health reimbursement arrangements, which are incredible. And many of these options are up to 60% less expensive than Obamacare.

CORNISH: Tell us more about these options.

SIMMONS-DUFFIN: So these are plans that you can buy that have really low premiums, like maybe $70 a month. But they might have really high deductibles, so if you get into an accident or you get really sick, you could be on the hook for maybe $12,000 before your insurance company is going to pay for anything. So he has made these skinny plans much more available than they were in the past. But it's not yet clear if there's going to be, like, a huge number - we're talking maybe a couple hundred thousand people - who choose these plans over ACA plans.

CORNISH: What are some of the other rule changes or regulations that have affected the ACA?

SIMMONS-DUFFIN: So a big one has been allowing states that chose to expand Medicaid under the ACA to institute work requirements. So they say if you want to have Medicaid and you're eligible for a work requirement that you have to work or go to school and document that to the state in order to continue to get this benefit. So this is all tied up in the courts right now, and so it's unclear if it's going to go into effect in the 18 states that have applied for something like this. But based on Arkansas' experience when it actually had this in effect for several months, a lot of people lost coverage because they just couldn't keep up with the requirements.

And another thing that I'll mention is that the administration stopped payments to insurers to help keep premiums down. That was really early on. And there was a workaround insurance commissioners found, so a lot of people didn't feel the effect on premiums that some people feared.

CORNISH: So no penalty for the individual mandate. You've got this cost-sharing rule that's changed. Big picture, is Obamacare actually dismantled the way the president pledged that he wanted it to be?

SIMMONS-DUFFIN: So it turns out these marketplaces are much more resilient than people expected. There has been some impact. It's probably all of these things have depressed enrollment. The uninsured rate has gone up for the first time since the ACA was passed. Premiums have gone up, probably in part because of all of these changes. But the marketplaces are still there. They're still running. People are still buying these plans.

I think the thing that he's really succeeded in is sowing uncertainty. Is this coverage still going to be there? Are these marketplaces going away? And in this event that he held earlier this month in Florida, the way that he talks about Obamacare - how it's going to implode - that has really contributed to the sense of uncertainty about the future of this law.

CORNISH: That's NPR's health policy reporter Selena Simmons-Duffin. Thanks so much.

SIMMONS-DUFFIN: Thank you.

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