Since Senate Republicans failed to pass a bill to repeal the Affordable Care Act last year, the Trump administration has taken several actions to undermine the ACA’s insurance markets. But recent developments may indicate that the administration is losing the battle on chipping away at a cornerstone of the ACA philosophy. Kevin Mowll, executive director of the RISE Association, reviews the latest actions as part of the bigger picture of what it may mean to the future of health care reform in the United States.

A recent Reuters/Ipsos poll reveals growing support among Americans for “Medicare for All.”

Indeed, 70% of the 2,989 American adults polled in June and July indicated they are in favor of a policy that would expand Medicare. Support crossed party lines—84.5% of Americans who identify as Democrats and nearly 52% who identify as Republicans said they were in favor.

 Kevin Mowll, executive director of the RISE Association, believes that this notion that “healthcare is a right” is gaining traction because of the moves that the Trump administration has made to destabilize the Affordable Care Act (ACA) health insurance exchange market. These actions include:

  • Reductions to cost-sharing payments to insurance companies, which has led to substantial increases in health plan premiums.
  •  The recent expansion of the sale and renewal of short-term health plans, also known as “skimpy” plans, because the coverage may be less expensive than plans in the ACA marketplace, but they also don’t cover as many medical services and can deny coverage to consumers with pre-existing conditions.
  • Failure to set enrollment targets for health insurance exchanges, and the reduction of funding for advertising and consumer outreach, including programs that promoted open enrollment and helped people buy insurance.

Consumers, Mowll says, have recognized that these actions are threats against their access to health insurance. “I think this is engendering a sense that people ought to have access to health insurance, that health insurance should be a right, not just something for those privileged by circumstances. This is becoming more a populist theme,” he says.

Latest actions to counter the sabotage of the ACA

Consider that movement with these recent developments and studies that may keep the ACA marketplace alive and viable, he says:

  • The Centers for Medicare & Medicaid Services (CMS) has approved a waiver to allow Maryland to create a state reinsurance program that will help stabilize the state’s individual health insurance market and prevent a massive rate hike. Maryland is the seventh state to receive approval.
  • During testimony before the Senate this month, CMS Administrator Seema Verma indicated her support to ensure there are protections in place for pre-existing conditions if the courts overturn the ACA, according to a Modern Healthcare report.
  • Attorneys General in 12 states and the District of Columbia are challenging the Trump administration’s final rule that expands Association Health Plans, which allow associations to market low-quality health care plans that avoid the protections under the ACA.
  • A report from the Government Accountability Office recommended that the Department for Health and Human Services take steps to improve ACA enrollment numbers by providing clear guidance to navigators on performance goals and ensuring the data they use to determine navigator awards is accurate.
  • A new study published in The Journal of the American Medical Association finds that increased access to insurance under the ACA led to fewer uninsured patients being hospitalized for serious heart conditions.
  • A new report by the Kaiser Family Foundation on pre-existing conditions finds that in some areas of the country, nearly 4 in 10 adults would likely be denied individual insurance coverage based on pre-ACA guidelines or under the short-term plans advocated by the Trump administration.

The fact that Seema Verma, head of HHS for the Trump Administration, is coming out in favor of supporting protection of pre-existing conditions and prohibiting the underwriting of pre-existing conditions under the ACA says that the Trump Administration is losing the battle on chipping away a cornerstone of the ACA philosophy,” Mowll says. “Similarly, with Congress pressing her, it shows that enough legislative support for this exists to reflect public sentiment around safeguarding some of the public policy gains achieved by the ACA."

Mowll notes that the fact that seven states have received approvals for reinsurance arrangements shows that states are gaining support for their efforts to reduce uncertainty and stabilize pricing at a lower level. “This also reverses some of the corrosion previously witnessed through political attacks on Obamacare,” he says. “If consumers can get a 30% reduction in their premiums through these state-level interventions, it goes a long way to signal to states that marketplace stabilization is now in their hands and that the Trump Administration will allow them to move forward."

The JAMA study also underscores that insurance coverage makes health care accessible and translates into better health outcomes, he says.

How the latest actions could impact the national health care reform movement

Taken together, Mowll said the country is witnessing a gradual reversal on key elements required for a national health policy strategy and a push for “Medicare for All”:

  • The definition and support of a government run marketplace for purchasing health insurance
  • The guarantee of consumer rights to insurance without limitation based upon pre-existing health conditions
  • The stabilization of community-rating at the expense of deregulated markets that cherry-pick based on health conditions

“In many ways, we may be witnessing the battle for hearts and minds around core elements that support health care as a right taking place in the relatively limited confines of Obamacare,” he says. “Yet, that philosophical battle is truly foundational for attitudes around a much larger concern that a majority of Americans share regarding the U.S. health care system. If the 'Medicare for All' movement continues to gain traction, it means that this sentiment is getting momentum and may become a wave that provides a platform for political action around another national health care policy debate.”

Interested in learning more? Oftentimes, the best way to learn how other plans are adapting to marketplace changes is to come to a live conference and hear from peers presenting their approaches and strategies. For example, check out our upcoming live event, The 12th Risk Adjustment Forum, for innovative strategies to improve risk adjustment programs for Medicare Advantage, Medicaid, and Commercial Plans.