Democrats have long been casting about for excuses for Obamacare's continuing slide toward failure. They have tried very hard to blame it on President Trump, even though the program's massive problems were evident when Trump was just a longshot primary candidate and President Barack Obama was calling all the shots.
Today, as the program continues to ruin the private insurance market, Democrats are trying to establish an excuse-in-advance for its complete failure. They are crying "sabotage" because the Trump administration is rightly moving to slash the advertising and promotional budget for Obamacare's health insurance exchanges. The complaint has no basis in reality.
Even if it had some kind of purpose in 2013, when Obamacare was new, the promotional budget associated with the program has been mostly a waste in recent years. There's little evidence that it has done much of anything to encourage people to sign up for the program, even where the amount dedicated to it has been sharply increased.
Obamacare's advertising budget was actually doubled last year from $51.2 million in 2015 to about $100 million in 2016. For all that extra spending, enrollments on HealthCare.gov actually fell modestly from 9.6 to 9.2 million. Though liberals would like to attribute this disappointment to the Trump's decision to halt advertising in the last week of open enrollment in January just after he was sworn into office, that affected just $5 million in ads in a $100 million budget. It would be hard to argue that this made anything more than a marginal difference in the enrollment picture.
For our own part, we will make our own patriotic contribution right here by reminding people that later this fall they can visit the notorious (infamous?) HealthCare.gov and sign up for a plan.
That cost us nothing to say. Taxpayers, on the other hand, are paying dearly for advertising that has fattened up certain firms but had negligible results.
The Trump administration's decision to slash the ad budget by 90 percent thus seems perfectly reasonable. If a $9.7 million budget is sufficient to advertise the Medicare Part D prescription drug program, then it's surely enough to advertise Obamacare's federal exchange, which has only about one-fifth as many enrollees.
The Navigator program, which connects potential applicants with a plan, appears to be an even bigger waste of money. In 2016, it had just over 100 organizations working in the 34 states with federal Obamacare exchanges, and taking a combined $62.5 million in grants. With those resources, it signed up just over 80,000 customers, or less than one percent of enrollees. More than three-quarters of the grantees failed to meet their enrollment goals, and in doing so consumed about $50 million, or most of that budget.
Many grantees took six- or even seven-figure amounts from the taxpayer and enrolled a relative handful of people in 2016. According to HHS, 17 navigator grantees enrolled fewer than 100 people each at an average cost of nearly $5,000 per enrollee. That's more expensive than a lot of people's annual premiums -- or at least it was before Obamacare.
The navigator program probably ought to be scratched altogether, but the Trump administration has shown laudable restraint by offering to pay navigators going forward based on the number of people they actually sign up. This isn't sabotage. It's common sense. No one has a right to take government money and lay idle. And this principle should be doubly true if you're actually interested in seeing Obamacare thrive. If the navigator program isn't adding people to its rolls, then it's just a form of what the Tammany Hall boys used to call "honest graft." Are Democrats really going to argue that the navigator grantee who in 2016 took $200,000 and enrolled literally one person deserves another year of living fat at taxpayers' expense?
Obamacare is what it is. It has gravely wounded the individual health insurance market and caused health plans to become more expensive and less attractive. In the meantime, it has helped many people with very low incomes obtain insurance almost for free, either through Medicaid or through subsidies.
After four years, most people have figured out whether they are one of the winners or one of the losers in the big HealthCare.gov experiment. On that basis, they have made up their own minds about whether to participate, or what measures they can or will take to avoid it, even if that means going uninsured or taking a job they might not otherwise in order to get health benefits that are relatively safe from a dysfunctional individual insurance market.
There are relatively few people left who are unaware of the website's existence at this point. No amount of promotion or advertising is going to change their judgment.