The Trump administration advised states today to disregard the Affordable Care Act rule that states that federal insurance subsidies can only apply to people purchasing insurance in marketplaces created through the ACA. These subsidies are the only form of government assistance for monthly insurance premiums.

This new advice is called “waiver concepts” because they target how states can work around the ACA, encouraging states to use the subsidies to purchase health plans outside of the ACA marketplace. These health plans are less expensive because they provide less benefits, coverage, and protections than health plans authorized under the ACA. This could potentially lead to states allowing subsidies to be used in combination with health care funds from employer health care plans or tax deferred savings funds to pay for premiums and medical expenses. If states follow the new advice, then it would seriously undermine the structure of ACA marketplaces, especially the nationwide standards for health insurance.

Currently, ACA market place health plans are the only health plans that people can use federal subsidies to pay for. This was designed to help low income and middle class families afford health insurance coverage. However, under the new advice from the Trump administration, states can change the income limits for subsidies.

The Brookings Institute released an analysis, questioning the legality of the new concepts released from the Department of Health and Human Services. Christen Linke Young from the Brooking Institute said that “there are serious questions” as to whether the advice and changes are legal and “at the very least, it is likely invalid.”

Previously, the Trump administration has focused on changing the types of health insurance plans offered by introducing inexpensive plans with less coverage that do not fit initial ACA requirements. Republicans in Congress have also consistently worked to repeal and weaken the Affordable Care Act and their most recent attempt would have allowed states to eliminate the ACA’s requirement that insurers provide Essential Health Benefits, including maternity and newborn care, mental health treatment, prescription drug coverage, access to birth control without co-pays, preventive and wellness visits, chronic disease management, emergency services, and pediatric care, among other critical healthcare services. Women disproportionately rely on these services, meaning that their attacks disproportionately threaten women’s access to care.

Media Resources: Washington Post 11/29/18; Feminist Newswire 4/27/17

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