Threats to Affordable Care Act Continue

Despite failing to legislatively repeal and replace the Affordable Care Act (ACA) last month, Congressional Republicans and Trump Administration officials are expected to continue attempts to undermine the ACA through what’s being characterized as a “synthetic repeal” through a series of administrative and budgetary actions. It is rumored that President Trump may soon sign an executive order to allow for new association health plans and/or to allow for the sale of insurance plans across state lines. Association health plans allow small employers to join associations – based on certain types of professional, trade, or interest groups – that offer insurance to their members. Proponents argue these would allow for more affordable coverage options.  However, these plans would also likely be exempt from many of the ACA protections such as covering people with pre-existing conditions or providing the ten essential health benefits.  As for selling insurance across state lines, insurers from lightly regulated states where policies may offer fewer benefits and lower premiums would be able to sell plans in highly regulated states. Some experts argue these actions could lead to financially unsustainable markets where healthier individuals flock to skinnier plans and less healthy individuals stay in comprehensive plans.

Another option to destabilize the ACA being considered by Congressional Republicans is to gut Medicaid and ACA provisions as part of their ongoing discussions to reform the country’s tax code. Proposed cuts to Medicaid and Medicare have been reported to be at least $1 trillion, in addition to significant reductions to ACA subsidies.