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Trump administration gives states new power to weaken Obamacare

The Trump administration is throwing open the door to states to make major changes to their Obamacare market...

Posted: Oct 23, 2018 12:44 AM
Updated: Oct 23, 2018 12:44 AM

The Trump administration is throwing open the door to states to make major changes to their Obamacare markets.

States can now apply for newly broadened waivers to create alternatives to the Affordable Care Act program, the Centers for Medicare and Medicaid Services said Monday. They could use this enhanced power to determine who gets financial assistance to pay premiums and to change what types of coverage are prioritized in the individual market.

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The announcement comes just two weeks ahead of the midterm elections. Health care ranks as one of Americans' top priorities, prompting candidates to attack each other on who would do more to reduce costs and protect those with pre-existing conditions.

The move will increase affordable insurance options, while retaining protections for those with pre-existing conditions, said CMS Administrator Seema Verma.

"The guidance that was in place before was really too restrictive and was thwarting innovation," Verma said. "We feel like this version provides that level of flexibility."

She added that the administration's goal was "to get states out from under Obamacare's onerous rules."

Health policy experts, however, immediately countered that it could leave low-income, older or sicker residents with fewer choices and higher costs while favoring the young and healthy.

The Trump administration has taken repeated steps to weaken Obamacare through smaller regulatory changes after Republicans in Congress failed to repeal the landmark 2010 health reform law last year. It has broadened access to two types of insurance policies that could come with lower premiums but provide fewer benefits than those found on the Affordable Care Act exchanges. It has also allowed states to impose new mandates -- particularly work requirements -- on Medicaid recipients.

Perhaps the biggest change states could enact would involve who would receive Obamacare's federal premium subsidies, which have been critical to sustaining enrollment in recent years. Currently, subsidies can only be used to buy policies on the exchanges and can only go to those who earn less than 400% of the poverty level (just over $48,500 for a single person or $100,000 for a family of four).

States could file waivers asking to provide subsidies to those buying short-term health plans, for instance, Verma said on a call with reporters. The Trump administration is pushing these policies, which have terms of less than a year, as a more affordable alternative to Obamacare. These plans typically have lower premiums so they could be more attractive to younger and healthier people who may not need all of the benefits required under Obamacare.

However, short-term plans are allowed to exclude people with pre-existing conditions. Obamacare advocates fear these plans will siphon off those with fewer health care needs, pushing up premiums for the sicker enrollees left in the exchanges.

States could also use the waivers to encourage more coverage among younger and healthier residents, Verma said. The agency will also work with states on options for insuring high-cost residents, which could help lower premiums for everyone.

Until now, seven of the eight state waivers that have received approval have been used to implement reinsurance programs, which help protect insurers against very sick enrollees. These programs have contributed to the 1.5% drop in the average premium for the Obamacare's 2019 benchmark plan, which President Donald Trump has repeatedly and inaccurately taken credit for on the midterm campaign trail.

The administration also made some key adjustments to how waivers would be evaluated. Requests will now be judged on how they affect coverage and affordability for residents in the state as a whole, rather than for specific groups of people, such as the poor or the sick. It emphasizes "access" to coverage, a favored Republican talking point.

The guidance takes effect immediately, but it will take time for states to file and gain approval for these waivers. The changes will not affect open enrollment for 2019, which begins on November 1, though they could be in place for 2020, said Verma.

Mississippi Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 15229

Reported Deaths: 723
CountyConfirmedDeaths
Hinds99925
Lauderdale73561
Madison72023
Scott65012
Neshoba63038
Jones59825
Forrest55338
DeSoto5337
Rankin4217
Leake42112
Holmes39728
Copiah3104
Jackson30513
Attala29216
Yazoo2734
Newton2714
Leflore25831
Harrison2577
Lincoln25628
Monroe25525
Lamar2355
Oktibbeha23512
Lowndes2119
Pearl River20931
Pike20211
Adams19615
Noxubee1856
Wayne1771
Warren1719
Washington1687
Covington1652
Bolivar16011
Jasper1574
Smith15011
Lee1496
Kemper14411
Clarke14318
Chickasaw13312
Lafayette1314
Coahoma1214
Carroll11711
Marion1159
Clay1124
Winston1121
Claiborne1112
Lawrence1021
Simpson1010
Yalobusha905
Hancock9011
Tate891
Grenada893
Wilkinson889
Itawamba877
Union835
Marshall833
Montgomery831
Sunflower813
Jefferson Davis772
Tippah7311
Panola703
Webster691
Calhoun644
Humphreys607
Amite601
Walthall550
Tunica543
Prentiss523
Perry503
Choctaw432
Jefferson421
Tishomingo320
Pontotoc323
Stone300
Franklin282
Tallahatchie271
Quitman260
George251
Alcorn171
Benton150
Greene121
Sharkey70
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 17359

Reported Deaths: 618
CountyConfirmedDeaths
Mobile2191115
Jefferson1780102
Montgomery163238
Tuscaloosa73814
Marshall6879
Franklin5457
Lee54033
Shelby50319
Tallapoosa42364
Butler40217
Chambers35325
Walker3442
Elmore3398
Madison3274
Baldwin2839
Dallas2603
Morgan2511
Etowah24811
DeKalb2433
Lowndes23812
Coffee2291
Sumter2206
Autauga2164
Houston2094
Bullock2034
Pike1980
Colbert1782
Russell1670
Marengo1636
Lauderdale1612
Hale1598
Calhoun1543
Choctaw1518
Barbour1501
Wilcox1447
Clarke1422
Cullman1260
Randolph1257
Marion12111
St. Clair1181
Pickens1114
Dale1100
Talladega1093
Chilton1001
Limestone940
Greene944
Winston880
Covington771
Jackson772
Crenshaw763
Macon754
Henry742
Bibb721
Washington686
Blount611
Escambia573
Lawrence480
Geneva400
Conecuh391
Coosa381
Monroe372
Perry370
Cherokee373
Clay272
Lamar230
Fayette150
Cleburne141
Unassigned00
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