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: 112123

Reported Deaths: 3223
CountyConfirmedDeaths
Hinds7796173
DeSoto670178
Harrison484483
Jackson435081
Rankin383786
Madison373993
Lee344979
Forrest296377
Jones283782
Washington252197
Lafayette242642
Lauderdale2376131
Lamar217138
Bolivar198377
Oktibbeha195854
Neshoba1814111
Lowndes174962
Panola166337
Leflore160787
Sunflower157649
Warren152755
Monroe145972
Pontotoc143819
Pike137256
Lincoln135555
Copiah135036
Marshall134826
Scott123829
Coahoma123436
Grenada120038
Yazoo119333
Simpson118649
Union115225
Holmes113560
Leake113340
Tate113239
Itawamba110424
Pearl River108958
Adams104343
Prentiss102619
Wayne98721
Alcorn96012
George93917
Marion92942
Covington92525
Tippah85921
Newton84427
Chickasaw82625
Winston82221
Tallahatchie81825
Tishomingo79341
Hancock78127
Attala77626
Clarke72349
Clay67621
Jasper67417
Walthall63327
Calhoun61412
Noxubee59617
Smith58316
Claiborne53216
Montgomery52923
Tunica52217
Lawrence49914
Yalobusha49314
Perry48122
Carroll46312
Greene45518
Stone45014
Amite41713
Quitman4146
Humphreys41216
Jefferson Davis39811
Webster36613
Wilkinson33020
Kemper32015
Benton3154
Sharkey27814
Jefferson27010
Franklin2373
Choctaw2036
Issaquena1063
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 153016

Reported Deaths: 2633
CountyConfirmedDeaths
Jefferson22563372
Mobile14335314
Tuscaloosa10023133
Montgomery9759196
Madison904893
Shelby709960
Lee644966
Baldwin640569
Marshall428248
Calhoun412759
Etowah405749
Morgan396833
Houston364632
DeKalb319628
Elmore310752
St. Clair282142
Limestone270828
Walker268892
Talladega258435
Cullman227623
Lauderdale208740
Autauga201029
Jackson200915
Franklin199731
Colbert192228
Russell19053
Dallas185627
Blount184824
Chilton181731
Escambia171328
Coffee16669
Covington166029
Dale163451
Pike130512
Chambers130143
Tallapoosa128686
Clarke127117
Marion104729
Butler99840
Barbour9889
Marengo97221
Winston90413
Geneva8417
Pickens80517
Lawrence80031
Randolph79814
Bibb79114
Hale74529
Cherokee72214
Clay71912
Lowndes70127
Henry6376
Bullock63517
Monroe6319
Washington62212
Crenshaw59330
Perry5806
Wilcox55912
Conecuh55713
Fayette55312
Cleburne5287
Macon52820
Sumter46721
Lamar4565
Choctaw38712
Greene33916
Coosa1973
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