Changing marketplace rules to drive up costs and create barriers to enrollment
What is it? The U.S. Department of Health and Human Services (HHS) has finalized a “market stabilization” rule which drives up consumer costs (such as deductibles), cuts the annual open enrollment window, and tightens rules around special enrollment periods.
What’s the damage? The changes will make it harder for people to sign up for coverage and make marketplace coverage less affordable for consumers.
When did this happen? HHS released the final rule on April 13.
Eliminating funding for financial assistance to help lower out-of-pocket costs
What is it? The ACA requires insurers to reduce cost-sharing, like deductibles and co-insurance, for lower-income marketplace enrollees. The government reimburses insurers for these reductions.
An unresolved lawsuit brought by the House of Representatives, House v. Price, challenges whether the administration can pay insurers this money without Congress actively appropriating the funds.
What’s the possible damage? If the federal government stops paying, it will have devastating consequences for marketplace stability. Many insurers could leave the marketplace altogether and the remaining insurers would likely increase premiums dramatically in 2018 to absorb the loss. Insurers need a firm commitment that these payments will be funded permanently by May in order to be confident about offering coverage for the 2018 plan year and beyond.
When could this happen?
On May 22, the Trump administration asked the U.S. Court of Appeals in DC for a 90-day hold before the Administration announces whether it will continue a cost-sharing program that pays for out-of-pocket expenses for millions of families. [Read our statement on this development.]
The Congressional spending package that was passed on April 28 doesn’t include dedicated funding for cost-sharing reduction subsidies, leaving uncertainty on how long the subsidy payments will continue.
Earlier, President Trump has indicated he might hold these payments hostage to force ACA supporters to negotiate. More recently, news reports say that he will pay – but it isn’t yet clear for how long. Either way, the House of Representatives must approve a path forward for funding cost-sharing reduction subsidies by May.
Allowing states to impose harmful new rules in their Medicaid programs
What is it? HHS allows states to modify their Medicaid programs through waivers, including Section 1115 Demonstration Waivers, which can be very broad. Such waivers could include work requirements and higher costs for enrollees as well as allow states to leave out mandatory benefits such as early childhood screenings.
What’s the possible damage? These policies make it harder for the lowest-income people to get health care through the Medicaid program.
When could this happen? Ongoing. States must first submit a waiver to HHS. Several states have expressed interest in these waivers, and the administration has already signaled willingness to fast track waivers and approve harmful policies.
Allowing states to weaken the ACA’s consumer and financial protections
What is it? The Administration could approve state requests to modify their implementation of the ACA. States can do this by applying for “Section 1332 waivers.” These waivers were originally intended to allow states to pursue innovative strategies to provide quality insurance while retaining basic ACA protections. But these waivers could also be used to weaken protections for vulnerable populations and/or to circumvent some of the consumer/financial protections in the ACA.
What’s the possible damage? States could use 1332 waivers to reduce coverage to vulnerable populations, or to make coverage less comprehensive or less affordable for these populations.
When could this happen? A number of states are exploring this option at the state level, after which they will apply for federal approval. At any time, the government could weaken federal guidance that currently protects low-income and vulnerable populations.
Creating obstacles to enrollment in marketplace coverage
What is it? The Trump Administration could seek to drive down enrollment and reduce the opportunities for people to enroll in coverage. They could do this by failing to enforce the individual mandate, cutting funds for navigators and assisters who help people enroll in coverage, and pulling back outreach and education efforts to encourage signups.
What’s the possible damage? Making it more difficult for people to enroll in coverage could lead to fewer people being able to successfully obtain coverage and lead to a less balanced risk pool – driving up costs for everyone in the marketplace.
When could this happen? Ongoing in 2017.
Rolling back ACA regulations related to consumer protections and benefit requirements for health plans
What is it? The Administration could attempt to undermine key consumer protections and benefit requirements of the ACA through weakening regulations that implement these parts of the law.
What’s the possible damage? By changing what health insurers are required to cover and what nondiscrimination protections enrollees have, the Administration could return the country to the days when health plans discriminated against patients with high needs. For example, these changes could make it difficult for people with pre-existing conditions to obtain affordable coverage that actually meets their health care needs.
When could this happen? Unclear, but theoretically it could happen at any time.