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Tomorrow is the beginning of the reduced, 45-day open enrollment period to sign up for individual plans on the Affordable Care Act exchanges. Healthcare.gov and the state-run exchanges should be up and running, and as we keep saying, the ACA is pretty damned hard to kill, even though the Trump administration has been trying its darnedest to sabotage the program and confuse people about whether the ACA even exists anymore. Unless there are more big Trump-Russia developments — or maybe especially if there are — expect the day to start with the “presdident” tweeting that the ACA really is dead, because the man can’t stop lying.

The administration’s decision to cut the open enrollment promotion budget by 90% is expected to lead to at least a million people just plain not signing up, for starters. That’s without all the other steps Trump has taken to harm the program. But things aren’t altogether grim for the ACA! In nine of the dozen states that set up their own exchanges, the states are actually running open enrollment past the December 15 cutoff for the federal exchange, for instance. Several states are also spending state funds to offset — at least in part — federal cuts to grants for “navigators” who help people pick a plan that will fit their needs. Nonprofit groups are also working to promote open enrollment, from the plucky Obama HHS veterans running Get America Covered to efforts by big tech companies:

Several tech companies with a wide reach among freelance workers — including Fiverr, DoorDash, Care.com, Etsy and Postmates — aim to reach millions of people through in-app messages, proprietary email lists, blog posts and other social media, said Brent Messenger of Fiverr. “Basically, every communications tool these partners have, we’re going to throw them at this problem,” he said.

All those efforts, of course, are no replacement for a government that actually does its damn job, or at the very least, isn’t actively trying to strangle healthcare for people because it promised it would strangle healthcare. The cuts to navigator groups are deep, and are going to hurt. A lot:

No state took a bigger hit than Indiana, which lost 82 percent of its anticipated funding from HHS’s Centers for Medicare and Medicaid Services. That is why Julia Holloway, who directs Affiliated Service Providers of Indiana’s navigator program, spent her birthday on Sept. 19 cutting the staff paid through that grant. It left her with one full-time and three part-time navigators, along with several funded through other federal programs, who will serve only Indianapolis and two nearby counties instead of the entire state.

South Carolina will be going from 62 navigators statewide to just 30, and will probably face more cuts for next year. Georgia will lose half of its 42 paid navigators, although it’s trying to get donations and train volunteers to pick up some of the slack. And Ohio, which used to have navigators in all 88 of its counties, has seen over two-thirds of its funding cut, so organizers are trying to persuade libraries to run volunteer signup events.

Take Georgia Republican Senator Johnny Isakson’s comment on the likely effects of this year’s truncated open enrollment as you will:

Maybe this enrollment period will produce the kind of problems necessary to get everybody’s attention that we need to get our house in order, and do the work we need to do to get the program fixed[.]

That would be the same Johnny Isakson who voted for the Senate’s attempts to pass “repeal-and delay” and “skinny repeal” in July, so by “fix” he means “dismantle.”

And yet! It’s not all terrible news. Even in a Trump HHS document that’s aimed at showing how terrible the ACA is, Topher Spiro of the Center for American Progress found yet another surprising indicator of how resilient the ACA has been:

What’s that chart? ENHANCE:

Of course, it’ll be harder for people to find the most affordable plans on their own, because the administration has been working so hard at its fuckery. And when ACA enrollment declines this year, thanks almost entirely to Trump’s sabotage, we can expect him to tout that as proof the program is failing. It’s going to be a shitty few years for people who rely on the ACA for healthcare, but that’s all the more reason to make sure we fight to keep Trump from sabotaging it further. Get out and support efforts to get people enrolled. Call your damned representatives. Elect Democrats, for Christ’s sake. Most important: take care of yourself and stay angry — then put that anger to work.

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[Politico / WaPo / Wapo / AJC / Image by Mikel Jollet on Twitter]

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