Pulse on Policy

Trumping Healthcare: Presidential Executive Orders and the ACA

In the months since taking office President Trump has acted decisively to undermine the health security of Americans that was established under the Affordable Care Act (ACA). The ACA, also commonly referred to as ObamaCare, currently provides health insurance to nearly 12 million Americans.

While the ACA remains the law, executive actions by the Trump Administration are chipping away at the Act’s ability to effectively protect Americans. So far, President Trump has: (1) reduced advertising and navigator funding for marketplace enrollment, (2) decreased the length of open enrollment period, (3) closed the marketplace for “maintenance” during peak enrollment times, (4) ended Cost Sharing Reduction (CSR) payments and (5) has allowed for skimpier plans.

Reduced Advertising and Navigator Funding for Marketplace Enrollment

The advertising budget for the 2018 open enrollment period for individual insurance policies has been cut by 90%, from $100,000 the previous year to $10,000 this year. The Department of Health and Human Services also cut funds by roughly 40 percent for nonprofit groups that employ “navigators,” the individuals employed to help facilitate enrollment in the individual market.

Decreased Length of Open Enrollment Period

The Open Enrollment Period runs from November 1st to December 15, 2017. This 45 day enrollment period is half of the time allotted to open enrollment in 2016 and is the first time that enrollment has not extended into January of the next year. When surveyed 85 percent of uninsured people did not know open enrollment began on November 1st and 95 percent did not know the end date of the Open Enrollment.

Closing the Marketplace website for “maintenance” during some of the highest traffic times.

The Department of Health and Human Services will shut down the federal healthcare exchange website, healthcare.gov, for all but one Sunday during the enrollment season. In comparison to previous years a federal report to Congress stated healthcare.gov was online 99.9 percent of the time during the 2015 and 2016 open enrollment seasons. However, this enrollment season the website will be open 93 percent of the time in an already reduced open enrollment season.

End to Cost Share Reductions (CSR), Effective Immediately

Cost Share Reduction Subsidies (CSRs) were created as part of the ACA to help compensate health insurers for lowering the copays and deductibles that their lower-income customers pay. CSR plans were available to people who earn too much for Medicaid coverage but are still low-income; they are individuals living between 201 to 250 percent of the federal poverty line. According to the Kaiser Family Foundation, more than half of people who bought individual insurance through ObamaCare benefited through CSR. On October 12, the Trump Administration announced that cost-sharing reduction payments would end, effective immediately.

Regardless of whether the federal government reimburses insurers for CSR subsidies, insurers are legally required under the ACA to offer reduced cost-sharing as part of the silver-level plans available to low-income consumers. Because of the threat to CSR, some health insurers had already increased their premiums for ACA plans in 2018 by as much as 20 percent before the announcement was made. Low to moderate income individuals and families in the exchanges should expect to see premiums rise dramatically, many by 19%.

Allowing Skimpier Plans

The Administration’s Executive Order – Promoting Healthcare Choice and Competition Across the United States – allows small businesses to purchase short-term policies for their employees that do not have to comply with ACA mandates to cover employees with pre-existing conditions. The implications of this order are that healthier and younger people will opt for the ‘bare bone’ plans that are cheaper while the sicker and older will opt for more robust healthcare plans and will experience significantly higher premiums.

Regional impact

The Center on Budget and Policy Priorities reports that in 2016. 164,453 Missouri residents enrolled in the Marketplace benefited from CSR. This is 57 percent of the enrollees for the entire state. In the immediate future, these changes to the Marketplace won’t impact the foundation of the ACA which remains intact. However, increased costs to premiums and logistical obstacles are expected.

For more information about the Affordable Care Act, visit the American Public Health Associationwebsite.

True, S., Caplan, E., Sprague, K., Raclin, L., Parker, G. (2017). Trumping healthcare: Presidential Executive Orders and the ACA. St. Louis, MO: The Clark-Fox Policy Institute, Brown School at Washington University in St. Louis

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