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ACA Sabotage: While the President undermines the ACA, Congress takes steps to maintain it

After three major failures by Senate Republicans to repeal and replace the Affordable Care Act (ACA), President Trump continued his efforts to undermine the law, announcing last Thursday that his administration would no longer make payments to health insurance companies – called Cost-Sharing Reductions (CSRs) – that cover some of the costs of medical care for low- to middle-income Americans. CSRs are a type of financial assistance applied only to silver coverage plans for individuals or families who make between 100 percent and 250 percent of the federal poverty standard. President Trump and other conservative critics have incorrectly referred to the CSRs as “bailouts” for insurance companies, but in reality, they are payments for subsidies of co-pays, deductibles and other out of cost expenses for people with low incomes. CSRs actually make health care more affordable for about 7 million Americans.

Stopping CSR payments, health analysts are predicting, will likely result in increased premiums for 2018 silver plans – about 20 to 25 percent higher, according to the Congressional Budget Office. It is also possible that insurers could drop out of the market altogether. Interestingly, 70% of the Americans who use CSRs to pay for their health care live in states that Trump won. Further, states in the Deep South which overwhelmingly went for Trump – namely, Mississippi, Alabama, Florida, and South Carolina – received some of the largest shares of CSR payments as they existed before President Trump cancelled them.

States and insurance companies are taking varied approaches to the news, as some had predicted that the Trump Administration would end CSR payments and others expected they would continue to be paid. One way that states are seeking to cope with higher-than-expected premiums is through a process called “silver loading,” wherein all of the extra costs will be added only to silver plans (as opposed to spreading them across the range of bronze to platinum plans). As a result, in some states gold and platinum plans will actually cost less than silver ones, although cost increases from purchasing a more expensive plan may still put health coverage out of reach for some Americans, particularly those who are not eligible for subsidies.

President Trump also signed an Executive Order to dismantle key portions of the ACA by broadening association health plans and expanding short-term medical insurance, both opening loopholes in the ACA to allow cheaper but skimpier health insurance plans. However these plans would not have to meet the same regulatory requirements of marketplace including requirements that plans must accept people with pre-existing conditions.  The Executive Order specifically directs federal agencies to review loosening regulations, so there will likely be an opportunity to comment publicly.  If the executive order is implemented, cheaper plans with fewer covered health services may attract younger, healthier people, leaving a sicker, older pool of people in state marketplaces, which could cause rising premiums with the potential to eventually drive insurers out of the market.

There are already efforts on the table in Congress to extend the funding for CSRs. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) introduced a bill with the bipartisan support of 12 Senators from each party, enough to overcome a filibuster if Senate leadership were to allow a vote.  The bill would provide short-term fixes to the problems the Administration has created with the ACA, giving Congress two more years to hash out a more permanent solution for our nation’s health care system. Scoring some wins for Republicans and Democrats alike, the stabilization legislation would:

Restore funding to CSRs for 2017-2019
Fund enrollment outreach that Trump slashed earlier this year and require reporting on enrollment 
Shorten the process by which states submit “Section 1332 waivers” in order to be granted permission to change their own health care systems
Maintain that state changes must have “comparable affordability” to existing plans for consumers
Protect essential health benefits and non-discrimination against people living with pre-existing conditions requirements

The two senators must now convince Senate and House leadership to allow a vote and convince the President to sign it.

At an event attended by AIDS United staff, Sen. Alexander called his bill the best way to “avoid chaos,” and AIDS United certainly agrees. In order to best support the needs of people living with and affected by HIV/AIDS, AIDS United is working on a strategy for active advocacy in coalition with many health care organizations to encourage Senate leadership to get the bill to a vote.  From there, we will continue to work on getting all Democrats and moderate Republicans in the House and Senate to support the bill and to pressure the President to sign it, assuming its passage.   


Posted By: AIDS United, Policy Department - Friday, October 20, 2017

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