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Independent Living News & Policy from the National Council on Independent Living

Information Alert: An Update on the Administration’s Recent Efforts to Undermine the Affordable Care Act

Last week, the Trump Administration took two actions to undermine the Affordable Care Act (ACA). We want to make sure you have an understanding of what these two actions mean, and how they may impact people with disabilities and / or pre-existing conditions.

October 12 Executive Order (EO)

Last Thursday, Trump signed an executive order directing three federal agencies (Health and Human Services, Labor, and Treasury) to create rules to allow the sale of insurance across state lines, expand the use of association health plans, and broaden the use of short-term / catastrophic coverage.

  • Association Health Plans (AHPs) provide small businesses with a way to pool together to buy insurance, and under the Affordable Care Act (ACA) they are required to cover all of the law’s essential health benefits. The EO looks to expand the use of AHPs, as well as to ease the federal rules around them.
  • Short-term limited duration insurance is intended to fill gaps in coverage by providing bare-bones coverage for up to 3 months. These plans are not required to abide by ACA regulations and they provide coverage that is far from comprehensive. The EO looks to expand the use of these short-term policies.

There is much uncertainty surrounding these directives, but there are several clear concerns. Easing the federal rules around AHPs could pave the way for these plans to be exempt from core requirements, like covering the essential health benefits. Expanding the use of both AHPs and short-term insurance will result in people with fewer healthcare needs leaving the ACA markets, resulting in higher costs and fewer options for people with pre-existing conditions and disabilities who need the protections and coverage mandated by the ACA.

October 13 Decision to End Cost-Sharing Reduction Payments

On Friday, Trump announced his decision to end cost-sharing reduction (CSR) payments to insurers. CSRs are payments made to insurers under the Affordable Care Act (ACA) to enable them to lower deductibles and out-of-pocket costs for low-income individuals. Eliminating these payments will make it significantly harder for insurers to provide affordable coverage options. With open enrollment just weeks away, it is too late for insurers to change their rates; however, it is expected that some insurers may decide to pull out of the market as a result of this decision. Moreover, we can expect further fallout in 2019. The CBO predicted that without CSR payments, premiums for silver plans will rise 20%.

Again, there is uncertainty surrounding this action as well. The pressure is on Congress, who can still pass legislation to fund CSRs. As of the time of publication of this article, Attorneys General from 18 states and D.C. have filed a lawsuit against this decision.

The full impact of both of these actions may not be known for some time, but what’s clear is that Trump has taken it upon himself to undermine the ACA however possible. And as we well know, efforts to undermine the ACA by loosening regulations, create plans outside the ACA markets, or deny legally required payments will harm people around the country and disproportionately impact people with pre-exiting conditions and disabilities.

NCIL will continue to keep you updated as more information becomes available.

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