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Major Reform Fails – Still Lots of Activity

Major Reform Fails – Still Lots of Activity

Now that major healthcare reform is off the table for the short-term, legislators and the Trump administration have started taking a series of individual actions to achieve their goals (some of which are completely opposite).

Addressing ACA’s Weaknesses

Senators Lamar Alexander (R) and Patty Murray (D), whose bi-partisan effort to address key weaknesses in the ACA was pushed aside during the Graham-Cassidy debate, have re-activated their talks which would address two immediate problems, cost-sharing reduction (CSR) payments and high-risk pools. Our article last month discusses this development in more detail.

Weakening the ACA

In a completely opposite direction, the Trump administration seems to be doing everything it can to weaken the ACA. The administration has:

  • threatened to withhold CSR payments to insurers causing them to leave the market or price up plans significantly to offset the risk (more details).
  • directed the IRS to relax enforcement of the individual mandate which encourages healthy individuals to opt out of purchasing coverage and leads to a less healthy insurance pool and higher rates.
  • dramatically reduced the budget for enrollment outreach which makes the insurance pool less diversified, less healthy, and subject to higher rates.
  • reduced the open enrollment period by 50%, from 90 days to 45 days and virtually ensures that a higher proportion of less healthy individuals, who absolutely must have coverage, enroll, further deteriorating the risk pool.
  • denied or slowed the review of waiver requests submitted by states that try to make improvements to stabilize the market.
  • stated that it will implement an executive order permitting association health plans to sell insurance across state lines, potentially damaging the small group markets in many states (more details).

The steps the administration is taking to undermine the ACA could lead to tremendous volatility in the individual market if there are no meaningful reforms to fill the void. The administration may be playing with fire. An implosion of the individual market, precipitated by the administration’s actions, will cause millions of individuals to lose coverage and may negatively affect many more. As a result, single-payer proposals could see a groundswell of support from a public that thinks a market-based system can’t work.

We all can agree that a single-payer scenario represents an existential threat to our business. With luck, bi-partisan efforts to temporarily shore-up the individual market will prevail, giving lawmakers the time they need to craft workable healthcare reform.

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