Trump Takes Further Steps to Sabotage the ACA

By Lena O'Rourke

Since he came into office, President Trump has taken a series of deliberate actions to undermine the Affordable Care Act (ACA), such as cutting back on advertising and funding for “navigators” who help people apply for insurance. Yesterday, in apparent frustration at Congress’s failure to repeal the ACA, President Trump took major steps to sabotage the ACA. First, he signed an executive order (EO) that directs relevant federal agencies to consider how to gut insurance protections and allow insurers to create bare-bones health plans that do not guarantee essential health benefits (such as maternity care and mental health treatment). Last evening, he announced that he would stop funding payments to insurers—known as Cost Sharing Reductions (CSR)—that help moderate-income individuals and families afford out-of-pocket health care costs.

Both of these actions create confusion and chaos leading up to ACA’s open enrollment, which starts in less than three weeks, on November 1. They will also raise insurance premiums for millions of Americans. By taking these steps, President Trump is threatening the health and wellbeing of hardworking people in order to score political points.

The EO gives the Department of Health and Human Services (HHS) marching orders to allow insurance companies to offer junk plans with scaled-back benefit packages; these will undermine the "risk pool" so that sicker and older patients pay more for comprehensive coverage. The order also allows health plans to offer plans outside of the ACA’s protections, effectively letting plans deny coverage to people with pre-existing conditions or charge them significantly more. While these changes will not take effect until HHS issues regulations, the announcement creates immediate uncertainty for health plans.

Ending the CSRs creates significant upheaval on the eve of open enrollment and will likely have a dramatic impact on the ACA’s marketplaces. Health plans are still required to help qualified individuals with the out-of-pocket costs of health care, but they will not be reimbursed for doing so. While the full impact of the changes is not known, premiums are likely to rise, which will particularly hurt people who buy on the individual market but don't qualify for financial assistance. Some plans will pull out of the marketplaces—leaving consumers with fewer options. In the longer term, this will create skyrocketing premiums and drive up federal costs. According to Congressional Budget Office (CBO) projections, premiums for the “silver” plans offered through the marketplaces would, on average, rise by about 20 percent in 2018 and rise slightly more in later years.

This undermining of the ACA by the Trump Administration does not affect Medicaid coverage, but it will do tremendous damage to low-income people in the Marketplace. Fortunately, Congress has the power to limit this harm. President Trump justifies his action on the grounds that the CSRs were guaranteed in the ACA but have not been explicitly funded by Congress. Congress should immediately act to improve market stability and fulfill its promise to insurers to make CSR payments. Senators Alexander (R-TN) and Murray (D-WA) have been working to develop a bipartisan solution to do just that. Unfortunately, the president has once again created instability and anxiety for millions of Americans who could lose their health care or face soaring premiums. Congress should immediately take up the bipartisan Senate proposal and enact it before open enrollment starts next month.