8 ways Trump hurt Obamacare in his first year

Within hours of being sworn in last year, President Trump signed an ...

Posted: Jan 21, 2018 7:13 AM
Updated: Jan 21, 2018 7:13 AM

Within hours of being sworn in last year, President Trump signed an executive order aimed at minimizing Obamacare's financial burden on the nation. It was his first attempt to dismantle his predecessor's landmark health reform law.

But it was certainly not his last. While Republicans in Congress failed repeatedly to repeal and replace the Affordable Care Act in 2017, Trump did take some major steps to weaken it.

Related: Trump issues executive order to start rolling back Obamacare

Here are some of the ways:

Limited support for open enrollment: The administration swiftly halted up to $5 million in Obamacare advertising in the final days ahead of the open enrollment deadline for 2017 coverage. A spokesman said at the time "We aren't going to continue spending millions of taxpayers' dollars promoting a failed government program."

Sign ups fell by half a million for last year.

The administration made even bigger changes to Obamacare's 2018 open enrollment season. It cut in half the time consumers had to sign up on the federal exchange, giving them only six weeks instead of three months. Officials also slashed the advertising budget by 90% and reduced federal support for counselors who help people navigate the enrollment process by more than 40%.

Related: Trump slashing Obamacare advertising by 90%

Still, 8.7 million people signed up for coverage in the 39 states on the federal exchange, only half a million fewer than the prior year. Many experts had expected a much larger contraction.

Killed the cost-sharing subsidies: In October, the administration stopped paying the cost-sharing subsidies that reimburse insurers for reducing the deductibles and out-of-pocket costs of roughly 6 million lower-income Obamacare enrollees. The funding had been the subject of a court battle between House Republicans and the Obama administration, with GOP lawmakers arguing the payments were illegal because Congress never appropriated the money.

Though insurers had warned earlier in the year that ending the cost-sharing subsidy funding could bring down Obamacare, the reaction was largely muted. That's because most carriers had already hiked premiums substantially for 2018 in anticipation of the move.

Related: Trump kills key Obamacare subsidy payments: What it means

In an unusual twist, Trump's move actually made Obamacare more affordable for many consumers. They benefited from higher premium subsidies that allowed them to buy some 2018 plans on the exchange for less than they were currently paying. However, middle class Americans who don't qualify for premium subsidies had to cope with the full rate hikes.

Eliminated the individual mandate: Congress did manage to effectively repeal the individual mandate, starting in 2019, as part of its tax overhaul legislation. Trump signed it into law last month.

Related: Will Obamacare survive the tax bill?

One of Obamacare's least popular provisions, the mandate requires nearly all Americans to have health insurance or pay a penalty. While the mandate's effectiveness is a matter of debate, many experts worry its elimination may prompt insurers to drop out and premiums to spike if fewer young and healthy consumers enroll on the exchanges. The Congressional Budget Office predicts that 13 million more people will be uninsured by 2027, though it is reviewing its methodology.

Earlier in the year, the administration took its own step to blunt the impact of the individual mandate. The Internal Revenue Service had been set to start rejecting tax returns last year that failed to indicate whether filers had health insurance, obtained an exemption or paid a penalty. But soon after Trump issued his January executive order, the agency quietly reversed that decision.

Gave states more control over Medicaid programs: States can now impose work requirements on Medicaid recipients for the first time. The administration released a guidance this month outlining what states need to do to mandate that certain enrollees work, volunteer or participate in other "community engagement activities" to qualify for benefits.

The Centers for Medicare & Medicaid Services is also encouraging states to submit waivers making additional changes to their Medicaid programs. States are requesting permission to charge recipients premiums, limit the time they can receive benefits, test them for drugs and lock them out if they fail to keep up with payments or paperwork.

Related: Here's how states are trying to overhaul Medicaid -- without Congress

"Medicaid needs to be more flexible so that states can best address the needs of this population," said Seema Verma, the agency's administrator.

Trump administration and state officials say these measures will help people gain independence and prepare them to purchase health insurance on their own. Critics, however, argue states are putting additional hurdles in place to winnow down their rolls.

Proposed allowing small businesses to buy health insurance together: The administration unveiled a proposed rule earlier this month that would make it easier for small businesses -- and some self-employed folks -- to band together and buy health insurance.

The proposed regulation stems from an executive order Trump issued in October. It would allow small firms to form association health plans based on their location or industry. Sole proprietors would also be eligible to join the plans, which would ideally be able to use their scale to secure less expensive coverage much like large employer plans do.

Related: Trump officials unveil rule that could chip away at Obamacare

Plans would be able to offer coverage across state lines, a longtime Republican goal and one of Trump's campaign pledges.

The associations could provide an attractive alternative to Obamacare for some people, especially younger and healthier consumers. But it could also damage the Obamacare exchanges, leaving them with mostly older and sicker enrollees and driving up premiums.

Encouraged the sale of short-term health plans: Trump's October executive order also directed agencies to consider expanding the availability of short-term health insurance policies.

The Obama administration limited the duration of short-term health plans to no more than 90 days in order to make them less attractive. While the administration hasn't yet issued proposed rules, it is expected to lift the cap, enabling consumers to buy policies that would last just under a year.

Short-term plans don't have to adhere to Obamacare's regulations so consumers would have a wider array of options with lower monthly rates. But they can exclude those with pre-existing conditions or base rates on consumers' medical history. They can also offer skimpier benefits so policyholders may have to pay more out of pocket if they actually need care.

Also on tap, the executive order would expand employers' ability to give workers cash to buy coverage elsewhere under a system known as health reimbursement arrangements.

Weakened the contraceptive mandate: Employers may now have more leeway to withhold birth control coverage on religious grounds, undermining the controversial Obamacare mandate that requires contraceptives be covered with no co-pay.

A broad range of employers -- including nonprofits, private firms and privately traded companies -- would no longer be required to provide contraceptives if they have sincerely held religious beliefs. The same provision applies to organizations and small businesses that have objections "on the basis of moral conviction which is not based in any particular religious belief," according to the administration.

Related: Trump administration deals major blow to Obamacare birth control mandate

Until now, a fairly limited number of employers -- mainly churches and some other religious entities -- could get an exemption to the mandate. Some others, such as religious-based universities or hospitals, could seek accommodations so that they didn't have to provide coverage, but their workers could still get covered contraceptives that would be paid for by the insurer or the employer plan's administrator.

Tightened the rules for consumers seeking coverage, while loosening them for insurers: The administration also made it harder to sign up for insurance at other times. Those seeking coverage during special enrollment periods because of a job loss, divorce or other major life changes have to provide documentation proving their eligibility.

Also, consumers now must pay any back premiums they owe before signing up again.

Insurers had long sought to tighten the rules, arguing that people are gaming the system and enrolling only when they get sick. Consumer advocates were concerned that it will make it harder for those truly eligible to qualify.

Related: Trump starts making changes to Obamacare that could cost consumers

Insurers, meanwhile, gained greater flexibility in the amount their policies would pay in each tier of coverage on the exchanges. A new "expanded bronze" plan option -- with higher deductibles and co-pays, but lower premiums -- debuted for 2018.

And the federal government pulled back on its reviews of whether insurers have enough doctors and hospitals in their networks. The Obama administration added this oversight after enrollees complained there were too few providers who accepted their plans.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 145636

Reported Deaths: 3745
CountyCasesDeaths
DeSoto973199
Hinds9668197
Harrison6898109
Jackson6178119
Rankin5319100
Lee487695
Madison4666106
Forrest371386
Jones346788
Lauderdale3355144
Lafayette317549
Washington3122107
Lamar283449
Oktibbeha240861
Bolivar240184
Lowndes229763
Neshoba2177115
Panola215849
Marshall209650
Leflore201490
Pontotoc196128
Monroe191477
Sunflower190555
Lincoln186865
Warren172657
Tate165451
Union163925
Pike160658
Copiah159540
Yazoo152039
Scott150729
Coahoma148743
Itawamba148234
Pearl River146567
Alcorn146327
Simpson145153
Prentiss141230
Adams137949
Grenada137745
Leake131943
Holmes126561
Tippah123030
George122324
Covington119737
Winston119124
Wayne116223
Hancock115939
Marion111646
Attala109833
Tishomingo106542
Chickasaw104132
Newton103629
Tallahatchie96327
Clarke88853
Clay87127
Jasper81222
Walthall75328
Stone73114
Calhoun72913
Montgomery72125
Carroll70614
Lawrence70314
Yalobusha70027
Noxubee69717
Smith69616
Perry65426
Tunica59619
Greene58422
Claiborne57616
Jefferson Davis55017
Humphreys52918
Amite51814
Benton48717
Quitman4816
Webster42114
Kemper41918
Wilkinson38722
Jefferson34211
Franklin3265
Choctaw3117
Sharkey30717
Issaquena1124
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Alabama Coronavirus Cases

Cases: 239318

Reported Deaths: 3532
CountyCasesDeaths
Jefferson31391491
Mobile19562361
Tuscaloosa12813154
Madison12741146
Montgomery12198235
Shelby1000577
Baldwin847398
Lee764466
Morgan634348
Calhoun6112115
Marshall607954
Etowah606565
Houston517038
DeKalb474736
Cullman428038
Limestone413744
St. Clair409055
Elmore400762
Lauderdale393653
Walker3588108
Talladega343453
Jackson307624
Colbert301941
Blount285539
Autauga268641
Franklin247833
Coffee239715
Dale230354
Dallas224531
Russell22053
Chilton219638
Covington216833
Escambia197431
Chambers173749
Tallapoosa173391
Pike157514
Clarke156319
Marion136535
Winston129923
Lawrence124836
Geneva12028
Pickens119418
Marengo119124
Barbour117010
Bibb116217
Butler114441
Randolph100921
Cherokee100824
Hale94531
Clay90223
Washington90219
Fayette87316
Henry8496
Lowndes79129
Monroe78111
Cleburne75714
Macon72321
Crenshaw70730
Bullock69119
Conecuh68314
Perry6756
Lamar6508
Wilcox63118
Sumter57122
Choctaw41913
Greene41418
Coosa3374
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