Earlier this week, the Trump Administration released its proposed budget for fiscal year 2019. This is the president’s first full budget proposal since taking office and it outlines the administration’s vision for the future. Although the budget proposal is non-binding and many elements need congressional approval for enactment, the administration can implement some of these policies on its own, through regulations, executive orders, and guidance. This is an eye-opening and chilling road map for where the administration wants to take health care for families and children.
Much of the report’s media coverage has focused on the projected 15 percent premium increase for 2019 as a measure of the damage being done by the Trump administration and its Republican allies in their ongoing campaign to sabotage health insurance markets. In truth, this sabotage has imposed a much higher cost on millions of families in America.
The Trump administration just released a final policy that will substantially increase the number of Americans who could be sold junk insurance in the form of “Association Health Plans,” or “AHPs.” This new and very dangerous step in the administration’s ongoing campaign to sabotage the Affordable Care Act could greatly reduce people’s access to essential health care, especially for those with preexisting conditions and older adults.
On July 7, the Centers for Medicare and Medicaid Services (CMS) announced a policy change that could fundamentally undermine the individual market, endangering health care for millions of people who get health care through the individual marketplace. CMS announced it will not distribute more than $10 billion out of a "risk adjustment" pool which is funded by insurers who participate in the individual and small-business markets. The risk adjustment program collects funds from insurers that cover healthier people and redistributes those funds to plans that have sicker enrollees.
Update: Judge O’Connor heard oral arguments in Texas v. United States on September 5, summarized in this Health Affairs article. It is not clear how quickly the judge will rule on a preliminary injunction. The Department of Justice, despite arguing to undo preexisting condition protections, has admitted that a negative decision, even if appealed, would bring chaos and uncertainty during open enrollment this fall.
The Trump Administration’s Continued Attacks on Immigrant Children and Families: Dismantling the Flores Settlement Agreement
On September 7, the Trump administration took another step toward eliminating basic protections for immigrant children and their families who enter the U.S. without documentation—including those legally seeking asylum, by issuing a notice of proposed rulemaking (proposed regulation) that would dismantle constitutional protections for children established by the Flores Settlement Agreement governing the detention and treatment of children in U.S.
On October 10, 2018, the Trump administration published a proposed rule in the Federal Register that would make it much harder for immigrants to obtain visas (including visas to study or work in the U.S.), extend their visas, or adjust their status to become lawful permanent residents.
New Guidance on Section 1332 waivers, issued in October 2018, can undermine key consumer protections and pave the way for federal dollars to subsidize plans that provide few benefits. The public can comment on the federal guidance through December 24, 2018. People should also find out if their states are developing waiver proposals, and comment on those to both the state and federal governments. This analysis explains what issues to watch.
UPDATE: 1/8/19 - Links to Families USA's comments on the proposed Program Integrity Rule are available here.