Tagline: Until the Work Is Done
Accelerated Attacks on the ACA
July 25, 2018 at 5:43 pm

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By Valerie Ploumpis, National Policy Director

Having failed in his efforts to force either the Supreme Court or Congress to repeal the Affordable Care Act (ACA) outright, Trump achieving his goal to sabotage the ACA by using the third branch of government – executive action.

In just the past few weeks, the Trump Administration has:

Slashed funding for ACA Patient Navigators:  On July 10, the Department of Health and Human Service’s Centers for Medicare & Medicaid Services (CMS) made a second round of deep funding cuts for ACA Patient Navigators (non-profit organizations that provide in-person assistance to help consumers choose which insurance plan best suit their needs and enroll for ACA coverage). Since Trump took office, Navigator funding has been slashed 80%, from $63 million under Obama to $10 million in 2018. These new cuts will likely leave consumers in some states without access to any in-person assistance.

Moreover, because Navigators only work with hard-to-reach and under-served populations – people with disabilities and other special needs, low literacy or non-native English speakers, those living in rural areas or no access to the Internet – they often also help eligible low-income people enroll in other programs like Medicaid and Children’s Health Insurance Program. Cutting funding for Navigators disproportionately hurts low-income people.

Beyond the Navigator program, CMS has also cut 90% of the funding for public education about ACA benefits – its 2017 budget for TV, digital, and other advertising from $100 million to $10 million. The cumulative effect from these cuts in public outreach will almost certainly depress Open Enrollment when it begins on November 1, 2018.

Suspended the Risk Adjustment Program:  On July 7, CMS shook health insurance companies when it suspended ACA risk adjustment transfers. This dry-sounding program is extremely important – it was the mechanism by which the ACA transferred revenues from insurers that enroll a healthier-than-average consumers to those that enroll more people living with chronic and complex conditions. HHS’s clear signal to interfere with the risk adjustment program going forward is a deliberate and frontal assault on ACA’s foundation – without ‘risk adjustment,’ insurance companies have no incentive to cover people who are older and sicker.

Allowed Junk and Short-Term Policies:  On June 19, the Labor Department issued new rules to permit Navigators to promote cheaper, skimpier policies with limited-benefit coverage options “such as association health plans, short-term, limited-duration insurance, and health reimbursement arrangements” to small businesses and self-employed people without meeting key ACA standards.

Opening the market to low-quality plans has a two-fold effect on people with pre-existing conditions: it creates the very real possibility that individuals will end up in “junk plans” that are attractive because of their low premiums, but that do not cover important services when people get sick; and it makes comprehensive coverage prohibitively expensive because the older, sicker and costlier risk pools are left behind.

Filed Suit to Allow Discrimination:  On June 7, the Department of Justice filed a brief to support Texas and 19 other states in a lawsuit to allow insurance companies to issue policies that discriminate against pre-existing conditions. In Texas v. United States, the Trump Administration asked the court to strike down two critical consumer protections: guaranteed issue (the provision that bars insurers from denying coverage to people with pre-existing conditions) and community rating (the prohibition on charging higher premiums to people because of their health status).

The ACA is Standing, But Swaying

The ACA extended comprehensive, largely affordable, non-discriminatory healthcare coverage to millions of LGBTQ Americans, many for the first time in their lives. Prior to Trump’s direct intervention, the health care insurance market had begun to stabilize.

But the combination of these four policies this summer, coupled with the president’s determination to “explode” the ACA with two other frontal attacks – his October 2017 decision to stop ACA cost-sharing reduction payments to insurers and the repeal of the individual mandate in the tax bill last December – are undeniably body blows that will result in dramatically higher premiums and greater uncertainty in the insurance marketplace.

Allowing insurers to once again exclude people with pre-existing conditions would affect 133 million people who could be charged more, denied coverage for certain diagnoses, or blocked from individual market coverage altogether. Eliminating these provisions could also allow insurers to charge higher premiums to women, older people, and people in certain occupations.

One of Equality California’s top priorities is to fight the Trump-Pence Administration’s unrelenting goal of unraveling the ACA. Realistically, almost nothing can be done to stop or delay executive action, but we will continue to fight hard against Congressional actions and protect LGBTQ protections in court.

But our greatest success might be found in blocking the nomination of Brett Kavanaugh to the Supreme Court, an implacable foe of the ACA. In his current capacity on the D.C. Circuit Court, he has tried a range of legal maneuvers: a procedural challenge that ACA had originated in the “wrong” house of Congress and a dissenting opinion that the ACA’s individual mandate would nullify the law’s requirement of coverage for those with preexisting conditions.

But for LGBTQ Americans, arguably his most troubling legal opinions related to the ACA were those based on religious grounds – citing Hobby Lobby in one case involving employer insurance coverage for birth. More alarming still was his extraordinary 65-page dissent in the Priests for Life v HHS case Kavanaugh wrote, ‘the President may decline to enforce a statute that regulates private individuals when the President deems the statute unconstitutional, even if a court has held or would hold the statute constitutional.’

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