Trump’s inaction on health care raises ire in GOP states, too

Noam N. Levey
Tribune Washington Bureau

WASHINGTON — As it works to roll back the Affordable Care Act, the Trump administration is letting state health initiatives languish, frustrating a growing number of state leaders, including several from solidly Republican states.

Last week, Oklahoma’s health secretary sent a blistering letter to senior administration officials, taking them to task for not approving a plan by state officials to protect their consumers from large premium increases.

“The lack of timely waiver approval will prevent thousands of Oklahomans from realizing the benefits of significantly lower insurance premiums,” Terry Cline wrote to Treasury Secretary Steven Mnuchin and Tom Price, then the secretary of health and human services.

Health officials in other states say the federal health agency for months provided little help as they tried to plan for the expiration of federal funding for the popular Children’s Health Insurance Program, known as CHIP. Money for the program, which covers nearly 9 million children, has begun to lapse because Congress did not meet a Sept. 30 deadline to renew the program, something lawmakers still hope to accomplish this year.

As the deadline neared, the Trump administration was working to support Republican attempts in the Senate to repeal the current health care law.

“It was very hard to get answers to our questions,” said Cathy Caldwell, who oversees the CHIP program in Alabama and, like many state officials, is trying to figure out when they must begin dropping children from CHIP coverage.

The federal health care agency did not respond to a request for explanations of its actions or response to the criticism.

Meanwhile, across the country — in Republican and Democratic states alike — there are questions about how the administration is running complex government health programs that serve tens of millions of people.

“There’s a problem here,” said Virginia Health and Human Resources Secretary William Hazel. “It may be deliberate sabotage at the very top. … But basic capacity seems to be an issue as well,” he said, noting vacancies and competing demands at the federal agency. Hazel, who is in a Democratic administration, was appointed by a Republican governor.

Minnesota’s human services secretary, Emily Piper, who oversees that state’s health care programs, said it has been hard to discern whether politics are driving all the problems, but the effect is the same.

“Basic services that we expect the federal government to provide are suffering,” she said.

Many health care programs that Americans rely on — such as CHIP, Medicaid and, in some cases, state insurance marketplaces created by the Affordable Care Act — are run by state governments, but funded and overseen by the U.S. Department of Health and Human Services.

That division of power has led to disputes between state and federal leaders.

The Trump administration has fueled additional tensions with its enthusiastic advocacy for Republican congressional efforts not only to repeal the current health care law, but also to significantly cut other federal health programs. Senior staff at the Department of Health and Human Services has been working all year to support the repeal campaign.

The Trump administration has further angered many states with actions that are driving up insurance premiums and destabilizing markets, according to insurers, state regulators and consumer advocates.

For example, President Donald Trump has repeatedly threatened to stop making federal payments to health insurers that offset the cost of covering out-of-pocket medical expenses for people with low incomes.

Insurers across the country have cited uncertainty over these payments as a leading cause for big 2018 premium increases.

Over the summer, the administration also announced plans to scale back advertising and other efforts designed to get people signed up for insurance coverage in 2018, saying much of that work had proved ineffective in the past.

An aggressive enrollment campaign is widely considered important to getting younger, healthier Americans into the insurance market and controlling premiums.

In the face of the Trump administration’s retreat, many states have intensified their own efforts to stabilize insurance markets and help consumers.

California, which operates its own insurance marketplace, has committed $100 million to a marketing and outreach campaign and developed a new system to shield some consumers from big rate increases.

Peter Lee, who heads Covered California, said the Trump administration has generally not interfered in the state’s marketplace.

But other states that have looked to the administration for assistance have been disappointed.

Oklahoma proposed a plan this year to control insurance premiums for its residents, who were facing increases of 30 percent or more next year.

After months of discussions in which state officials said the Trump administration assured them approval would come, the administration took no action, letting a deadline pass and ensuring that health insurers would pass along major premium increases to customers next year.

“It was very frustrating,” said Julie Cox-Kain, Oklahoma’s deputy health and human services secretary.

States looking for guidance over the summer about how to prepare for the expiration of federal funding for CHIP were similarly let down, officials said.

Several said they felt that their warnings about the need for action well before the Sept. 30 deadline were being ignored by federal officials.

“It’s been a budgeting nightmare,” said Caldwell, the Alabama CHIP official. “And it is very stressful for families.”

Most states have enough money in reserve to continue CHIP coverage for weeks if not months, but all need several months of lead time to plan for freezing enrollment or cutting coverage should that become necessary.

In the past, administrations have helped states prepare for that possibility with written guidance about how to prepare.

But for months, the Trump administration refused to provide states with anything in writing, Caldwell said.

More recently, as the CHIP deadline passed and state pleas intensified, federal officials began offering more assistance, several state officials said. Caldwell said she finally got critical information about how much federal funding was still available to Alabama.

Minnesota, which has little money in reserve for its CHIP program, last week received additional federal money to help tide it over until Congress reauthorizes the CHIP money.

But Piper, the Minnesota human services secretary, said she’s still not convinced that the Trump administration is pushing Congress to quickly renew the program.

“I have never received any assurances that this is a priority for them,” she said.