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. The
    Congressional Budget Office has estimated this will cut 338 billion from funding
    for the Affordable Care Act by 2019.
  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.

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.

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