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Thursday, November 22, 2018

Changes Undermining the Affordable Care Act Under the Trump Administration

Since the Republicans took control of the federal legislative agenda in 2016, they have been hell bent on getting rid of the Patient Protection and Affordable Care Act (ACA), known as Obamacare. This 2010 landmark legislation, still covers nearly 12 million enrollees and their families through private insurance plans and was REVENUE NEUTRAL through 2016. Annual open enrollment for Obamacare runs until December 15th and is accessible through government run insurance exchanges.
Briefly here are the changes the Trump Administration has made to the Affordable Care Act:
  1. Removed the individual penalty for lack of medical insurance, which only applied to people who didn’t qualify for any of the existing exemptions, such as; religious objection, insurance falls outside the range of affordability, hardship provision, etc.[1] The Congressional Budget Office has estimated this will cut 338 billion from funding for the Affordable Care Act by 2019.[2]
  2. Removed the 2.3% tax from the lucrative medical device industry, which provided funding for the Affordable Care Act; cutting about 3 billion a year from the government subsidized insurance program
  3. Cut the open enrollment period in half from twelve weeks to six, which is the period when individuals can elect or change insurance plans without a change in family status
  4. Reducing advertising and even web site information on the Affordable Care Act, which has made it more difficult for people to obtain information and enroll. 
Affordable Care Act Affects Most Insurance Plans
The Affordable Care Act impacts nearly all medical insurance plans in the United States through a variety of provisions about nondiscrimination based on health, linking healthcare quality to reimbursements, and standardization of coverage. This table shows where people obtain their insurance in the United States.

Employer Plans
Insurance Exchanges
Population Covered
Slightly more than half of all U.S. businesses offer medical insurance to their workers (56%).[3] But the rate of employees who obtain medical insurance through work was less than 50% of the population in 2016 (49%). The rate of employer coverage also depends on where you live.  Private employers receive 250 million in tax subsidies for offering medical insurance to their workforce.[4]
This map from the Kaiser Family Foundation State Health Facts site shows the percentage of employers which provide medical insurance for their employees across the United States.

Though the Trump Administration has cut funding for the promotion and support of the ACA in 2018 there were nearly as many participants as in previous years. People like the access to an array of insurance plans which are subsidized by government tax credits and enrollment has remained steady over the years. Further, many of those covered under the ACA lacked access to healthcare before 2010, because they work for employers who do not provide health insurance, are self-employed, disabled, or have a pre-existing condition.
Next Up on the Trump ACA Attack
The Affordable Care Act mandates that insurance companies may not discriminate or deny coverage to persons with pre-existing conditions. The Trump Administration wants to reduce this protection by allowing insurance companies to circumvent the ACA requirement by offering contracts not subject to the ACA protections. These types of contracts already exist and take the form of travel insurance policies or special risk contracts. Student insurance is another example, but since the ACA allows youth to remain on their parents medical plan until age 26, those have declined in popularity. Also, many students are enrolled on Medicaid plans while they complete their education. Foreign students must obtain private medical insurance, which is offered through their universities. Make no mistake about it, offering more restrictive but cheaper insurance contracts hearkens back to the old insurance offerings including; life time limits on benefits, exclusions for certain conditions, conditional insurability, and other fine print.
The Trump Administration also sought to eliminate the risk sharing funding that insurance companies received, as a part of the ACA, to offset higher costs from accepting all people, regardless of health, and not being able to charge more for risk in the insurance exchanges. However, for the moment this effort has been defeated due to lack of Congressional support, which will erode further when the Democrats take back the House of Representatives in January. 
And this is the healthpolicymaven wishing you a content Thanksgiving and encouraging you not to sign blanket release forms for medical procedures, do stipulate that for which you consent and that for which you decline. Also, be careful about the information you share with insurance companies, which will be used to figure out what to charge and how to market to consumers, not necessarily to improve your health.
 Roberta Winter is a freelance writer and health policy analyst and all opinions expressed here are her own, not subject to corporate funding or dictates. She is the author of a guidebook to the U.S. healthcare system,