In the absence of legislation around immigration reform, Barack Obama used executive actions to create policy, i.e. now we have DACA. Taking a similar page out of the presidential playbook, Donald Trump is using executive orders to bring about a retrenchment from the Affordable Care Act.
Today there was not one, but two, EOs that will increase uncertainty in the health insurance marketplaces, such as Covered California.
- Association Health Plans and Short-term Insurance: AHPs are plans for small businesses (and maybe self-employed individuals) who band together. Both AHPs and short-term plans can lead to a broader range of cheaper insurance options- in part because neither one has to meet ACA or state requirements, e.g. these plans do not have to cover essential health benefits such as prescription drugs (required for the marketplace plans). Healthy people who don’t need comprehensive coverage will be drawn to the cheaper AHPs and short-term plans, leaving behind sicker people in the marketplaces. The more sick people are packed into the marketplace, the higher premiums will go.
- Cost-sharing subsidies: These are payments that the federal government makes to help cover the costs of co-payments, deductibles, etc., for low-income people buying insurance in the marketplaces (over half of buyers). Without the subsidies, health insurance plans will (and have already, due to uncertainty) increased premiums.
Both EOs could also make the cost of doing business in the marketplaces too high, and insurance plans may simply drop out.
*Now both EOs are likely to trigger lawsuits from states (1) and insurance companies (2) so it’s likely not much will happen yet. (2) can also be resolved by an act of Congress.
However, Congress has not yet renewed funding for the Children’s Health Insurance Program, employers are not required to offer plans with contraceptive coverage, and Puerto Rico–still struggling for clean drinking water and electricity– is on a Medicaid block grant.
I try to conclude these posts with a summary for implications for disparities- but they all seem to come to the same conclusion: if these EOs come to pass in the absence of other reforms, disparities by income, race and ethnicity, and gender, are all likely to widen. For all the new choices available, those with chronic and pre-existing conditions will likely see their premiums go up.