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ROUNDUP: Experts Slam Trump’s Backdoor Repeal through 1332 Waivers

By October 23, 2018No Comments

Experts condemned the Trump Administration’s new federal policy to water down the guardrails ensuring health insurance plans sold in states that are seeking approvals of “1332 waivers” provide the full range of benefits and the cost-sharing protections in the Affordable Care Act. Here’s a look:

Larry Levitt, Senior Vice President Of Kaiser Family Foundation: Trump 1332 Waiver Guidance Gives States Much The Same Flexibility As Repeal Would. “Republicans couldn’t repeal and replace the ACA last year, but this guidance gives states the flexibility to shift the law in much the same way…It’s hard to overstate how much flexibility states will have under the Trump administration’s new guidance for ACA waivers,” he said. “This will likely widen the gap between red states and blue states for access, affordability, regulation, and protections for pre-existing conditions.” [Business Insider, 10/22/18]

HuffPost: 1332 Waiver Rule Change “Almost Certainly Means That, Overall, People With Serious Medical Problems Are Likely To Have A Harder Time Finding Coverage.” “But Monday’s rule change almost certainly means that, overall, people with serious medical problems are likely to have a harder time finding coverage ― and, ultimately, paying their medical bills. Under guidance from the Department of Health and Human Services that takes effect immediately but likely won’t affect insurance markets for another year, state governments will have new leeway to request waivers from some of the federal health care law’s core requirements…But this latest regulatory change is a reminder that the GOP has never given up on its goal of wiping ‘Obamacare’ off the books, and that people with serious medical problems are likely to suffer as a result.” [HuffPost, 10/22/18]

Axios: The Waiver Announced Yesterday “Could Add Up To One Of Its Most Substantive Blows Yet Against The Affordable Care Act.” “As in-the-weeds as a revised waiver process sounds, the practical effects of what the Trump administration announced yesterday could add up to one of its most substantive blows yet against the Affordable Care Act…Under the Obama administration, states seeking a waiver from the ACA’s rules had to show that their alternatives would cover just as many people as the ACA, with insurance that’s just as robust, for the same cost. That’s why only 8 waivers have ever been granted. But under the Trump administration’s approach, if the same number of people have access to ACA-level coverage, that’ll count — even if few of them actually choose it.” [Axios, 10/23/18]

Sabrina Corlette, Research Professor At Georgetown University: New Guidance Essentially Means That It’s Okay If Certain Subpopulations Are Harmed So Long As Things Work Out In Aggregate. “‘The guidance under Obama… meant that a state’s plan couldn’t result in fewer people enrolled in affordable, comprehensive coverage,’ Corlette explained. ‘This new guidance is saying that so long as people in the state have ‘access’ to [comprehensive] coverage, it doesn’t matter what they actually do… If un-insurance spikes or there’s a big movement to [less comprehensive plans] a state won’t get dinged for that.’ Corlette noted that the Obama administration insisted that state waivers not hurt certain vulnerable populations, including those with severe medical needs. ‘This is saying that so long as things work out in the aggregate, then it’s OK if certain subpopulations are harmed,’ she said.” [HuffPost, 10/22/18]

Waiver Could Allow States To Let Residents Use Subsidies Intended For Comprehensive Coverage To Cover Junk Plans. “Perhaps the biggest change states could enact would involve who would receive Obamacare’s federal premium subsidies, which have been critical to sustaining enrollment in recent years. Currently, subsidies can only be used to buy policies on the exchanges and can only go to those who earn less than 400% of the poverty level (just over $48,500 for a single person or $100,000 for a family of four). States could file waivers asking to provide subsidies to those buying short-term health plans, for instance, Verma said on a call with reporters. The Trump administration is pushing these policies, which have terms of less than a year, as a more affordable alternative to Obamacare. These plans typically have lower premiums so they could be more attractive to younger and healthier people who may not need all of the benefits required under Obamacare.” [CNN, 10/22/18]

New York Times: Timing Of The Announcement Was “Puzzling” Coming Just Before An Election In Which Protection Of People With Pre-existing Conditions Has Been Top Tier Issue. “Coming two weeks before Election Day, the new policy appeared to be a political gift to Democrats, who are making health care a potent campaign theme…The timing of the announcement, just before an election in which the protection of people with pre-existing conditions has been a top-tier issue, was puzzling.” [New York Times, 10/22/18]

Trump Administration Opening Door For States To Gut Protections For People With Pre-existing Conditions. “But the latest administration proposal to weaken insurance standards comes as President Trump and Republican congressional candidates are intensifying their bid to convince voters that the GOP backs patient protections in the 2010 law, often called Obamacare…The new proposal from the Department of Health and Human Services and the Treasury Department would not explicitly scrap the law’s protections, which bar health plans from denying coverage to people with preexisting medical conditions. But the administration plan would dramatically reshape rules established by the 2010 law that were designed to prevent states from weakening these protections.” [Los Angeles Times, 10/22/18]