The Trump administration’s “death by 1,000 cuts” strategy against the Affordable Care Act took a step forward Tuesday morning with a proposal from HHS to allow insurers to sell skimpy short-term plans that don’t comply with the ACA’s rules. When finalized, this rule could create a parallel market where insurers can once again turn away people with preexisting conditions, charge sicker people higher premiums, and refuse to cover services as basic as emergency room visits and prescription drugs.
Meanwhile, as the rollback of federal oversight and regulation continues, Idaho is emerging as the state most determined to test how far the administration will allow it to go in flouting the rules that remain. The state recently moved to allow insurers to sell cheap plans that don’t meet the ACA’s minimum standards. Speculation that no insurer would actually offer these bare-bones plans for fear of being sued was put to rest this past week when one of the biggest companies in the state’s market—Blue Cross of Idaho—announced it would begin offering these plans this year. The state is allowing insurers to exclude coverage of maternity care, put a lifetime limit on a patient’s expenses, and charge people higher premiums if they have a preexisting condition—all policies that violate the ACA.
Newly sworn in HHS Secretary Alex Azar has so far signaled he is unlikely to crack down on Idaho. Testifying before the Senate Finance Committee last week, he said only that his agency would scrutinize the state’s move, which he called “a cry for help.” Health law professor Nicholas Bagley has another term for it: “Crazypants illegal.”
Some states, however, may be moving in the opposite direction. After a blue wave election in Virginia, those who have fought for years for the state to expand Medicaid see signs of hope. The state budget released this past week by the House of Delegates would expand Medicaid to an additional 300,000 people. The Republican-controlled state Senate, however, did not include Medicaid expansion in its budget, setting up a potential clash between the two chambers. The House’s plan may also be a tough sell for progressives because it would require Medicaid beneficiaries to work or attend job training and pay premiums.
Obamacare’s individual mandate will end next year, and federal offices are clashing over just how many people will drop or lose their insurance coverage. The Congressional Budget Office initially estimated that 13 million more people would either voluntarily or involuntarily go uninsured over the next decade as a result of the mandate’s repeal. But a report from HHS’ Office of the Actuary forecasts only 4 million newly uninsured people. The main discrepancy between the two estimates revolves around the question of whether people who qualify for significant federal subsidies or entirely free Medicaid coverage will stay enrolled once the mandate’s tax penalty disappears.
As I wrote late last year, Congress steered the country into uncharted waters when it repealed the mandate. The exact nature of the fallout won’t be known for years to come.
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