Администрация Трампа ввела правила, позволяющие снова продавать дешевые катастрофические страховки и подорвать Affordable Care Act

Our laws are the only thing preventing socialism from marching through the United States from coast to coast. Not the laws of the United States. The laws of mathematics. Consider, for example, the program known as ObamaCare, formally named the Patient Protection and Affordable Care Act (ACA). It could have been named Socialism for Beginners. The idea was to compel everyone to buy health insurance with mandated coverage for things everyone didn’t necessarily need, and use the extra premium revenue from younger and healthier people to subsidize the cost of insurance for people who were going to need more and costlier medical care. The ACA was just barely passed by Congress and just barely upheld by the U.S. Supreme Court, so it’s the law of the land. Unfortunately, the laws of mathematics are enforced separately. The latest battle over the unaffordability of the Affordable Care Act is playing out now in a lawsuit filed in late July by 22 states. Math-challenged California is leading the indignant mob in this effort to block a new federal rule that sets standards for health plans offered in 2027. The Trump administration’s new rule allows people to buy policies that cost a lot less and have high deductibles. These are known as catastrophic health insurance plans. They used to be legal, before Obamacare made them illegal except in very limited circumstances. Catastrophic coverage was an affordable option for younger, healthy people who could afford to pay for the limited amount of routine medical care they needed, but wanted to have insurance to cover the unaffordable costs if something awful happened. It was also useful for maintaining continuous coverage, which protected against the risk of being excluded from coverage later because of a pre-existing condition. The Affordable Care Act eliminated the risk of being unable to buy insurance because of a pre-existing condition, but the laws of mathematics could not be evaded. Insurance companies were not going to survive in a system that allowed people to wait until they were ill or injured to buy health insurance. So everybody was forced to buy insurance, insurance companies were forced to sell coverage to anybody without pricing risk into the premiums, and younger, healthier people were forced to pay for more than they needed in order to make the risk pool less of a cesspool. It was a little experiment in socialism, using the force of government to harm some people for the benefit of other people, all the while insisting that this was a “market.” Right from the beginning, it was obvious that the math was going to be uncooperative. For this reason, the law included a two-year “risk corridor” program that was supposed to end in 2016. Under the “risk corridor” program, the Department of Health and Human Services would collect money from insurers with healthier customers and lower costs, then give the money to insurers with sicker customers and higher costs. In 2014, HHS collected $362 million and owed $2.87 billion. Insurers received 12.6 percent of the money they expected. A number of health insurance companies filed lawsuits over the underpayments. A three-judge panel of the Court of Appeals for the Federal Circuit ruled 2-1 against them. The court held that because Congress passed appropriations riders that said HHS couldn’t pay out more in risk corridor payments than it collected, the insurance companies could not collect on the debt, which had reached $12 billion by 2016. In 2020, the Supreme Court reversed that decision in an 8-1 ruling, holding that the ACA said the insurers would be paid, and the fact that Congress didn’t want to pay them was not enough to escape the obligation. The Trump administration’s new rule allowing catastrophic health insurance policies to be sold again may accomplish the president’s longtime goal of forcing a reform of the unaffordable Affordable Care Act. By allowing younger, healthy people to escape their socialist duties to pay more so others can pay less, the change removes one of the supports keeping the failing program going. The 22 states that are suing to block the rule complained in their lawsuit that “some enrollees might be tempted to switch from a metal-tier plan to a catastrophic plan, attracted by the lower premiums.” This opportunity for individuals to do what’s best for themselves, something that used to be called “freedom,” can’t be allowed, the lawsuit contends, because “individuals in that group would likely be healthier — i.e., less likely to utilize healthcare — and therefore likely younger. This would concentrate risk in the population that remains in the metal-tier plans, raising premiums and destabilizing the individual market.” The lawsuit cites, with some alarm, a 2025 White House Council of Economic Advisors report that predicted 3 million Americans would enroll in catastrophic insurance plans under the new rule. Democrats have been unanimous, or nearly so, in their demand for the renewal of temporary enhanced premium subsidies that were enacted during the COVID era and then expired, as Democrats had agreed they would. It turns out that the Affordable Care Act isn’t affordable without substantial additional subsidies from taxpayers, over and above the Premium Tax Credit. The Affordable Care Act offered up a promise that everyone can have everything at everybody else’s expense. The laws of mathematics enjoy a good laugh. Now, some people who make too much money to qualify for subsidies but not enough to afford the ACA insurance “market” premiums and co-pays are dropping their insurance. Catastrophic plans will be a good option for many, but not so good for the 22 states that want to keep younger, healthy people harnessed like mules to make the math work. The new federal rule may break the Affordable Care Act, but the rule shouldn’t be blamed. Socialism is just bad at math. Write [email protected] and follow her on X @Susan_Shelley