Multiple threats to the Affordable Care Act continue to chop away at the protections the law provides to millions. For example, a lawsuit filed in February by Texas and 19 other states contends that the repeal of the ACA individual mandate penalty included in the recent Republican tax cut bill means the entire ACA is unconstitutional. The Trump Administration declined to defend the law. In response, several Senators introduced a resolution to authorize the Senate to take legal action to intervene in the lawsuit to defend the law and its protections for people with preexisting conditions.

In addition, according to Families USA, the Trump Administration on June 19 finalized a regulation allowing the sale of substandard junk plans that aren’t required to cover the 10 essential health benefits and exempting these plans from limits on premium increases based on gender and geography. Under the new regulation, Association Health Plans could be sold to millions of Americans buying insurance in the individual or small group markets. Several Democratic attorneys general have announced they would sue to overturn the regulation. The Administration has also proposed a rule for so-called “short-term insurance” plans that ignore nearly all ACA consumer protections and that could last for up to 364 days (and would be renewable after that). The current rules limit short-term plans to 90 days.

On July 7, the Centers for Medicaid and Medicare Services (CMS) announced it will not distribute more than $10 billion out of a “risk adjustment” pool, which is funded by insurers who participate in the individual and small-business markets. The pool balances out the risks among these insurers; failing to pay these adjustments could cause insurers to pull out of these markets or to increase rates and could therefore undermine the individual market. And on July 19, CMS launched a new comment period ending August 18 to accept feedback on Kentucky’s efforts to add work requirements for Medicaid recipients. A federal judge in June struck down the proposal, which the state has estimated would cause 95,000 Kentuckians to lose Medicaid coverage, calling it “arbitrary and capricious.” The new comment period could serve to advance the proposal again. Kentucky officials on July 19 also said that it was working to reinstate dental and vision coverage for Medicaid expansion beneficiaries, after the governor canceled that coverage following the court decision.

The Protect Our Care Coalition, of which CHN is a member, recently released a report, Summer of Sabotage, that analyzes a number of actions the Trump Administration has undertaken to undercut health care in the last few months. In addition to providing a status report on the premium increases insurance companies have filed this summer, the report contends that the Trump Administration has argued against protections for people with preexisting conditions in federal court; encouraged Americans to sign up for junk plans, which would bring back discrimination against women, people with preexisting conditions and people over age 50; nominated an extreme anti-health care judge to the Supreme Court with the nomination of Judge Brett Kavanaugh; slashed funding for navigators that help Americans obtain insurance; restricted access to Medicaid in the states; made it harder to find information about the ACA online; and froze the risk adjustment program, which could unnecessarily drive up premiums. Families USA has a number of resources on these restrictions; many of them are linked to in the above paragraphs and can be found on their website.

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