While Congress has thus far in 2018 declined to take up legislation that would dismantle affordable access to health care that was a hallmark of their 2017 agenda, the Trump administration continues to move forward with a number of regulatory initiatives that will continue to advance this misguided approach and cost more Americans the coverage they need.
One plan the administration is currently discussing would allow for wider availability of short-term, limited-duration insurance plans that cover patients for less than a year; another would permit the self-employed and small business employees to make use of association health plans. In both cases, coverage offered would not be required to meet the list of essential health benefits that the Affordable Care Act (ACA) currently requires.
As a result, a vast majority (more than 95%) of healthcare groups that submitted comments on President Trump’s recent plan to scale back these protections said that such an approach was a mistake.
Meanwhile, many of those same groups have come out in opposition of a proposal that would weaken Medicaid by creating work requirements for certain adult recipients who have benefited from Medicaid expansion. While specific efforts to implement such requirements are being led by state governments, it was the administration’s decision to allow such proposals in the first place that has enabled them to do so.
The administration’s argument, however, is disingenuous at best, as that Medicaid expansion provides healthcare coverage to working, low-income Americans. According to a December 2017 Kaiser Family Foundation issue brief, roughly 6 in 10 of the 22 million non-disabled adults receiving Medicaid benefits are employed either full- or part-time, while 8 in 10 live in a working family. Most of these individuals work either for small firms or in low-paying industries which do not offer healthcare coverage, and thus rely on Medicaid for health care.
Further, among those adults who are not working, most report a major barrier to employment such as illness, disability, or care-giving duties. According to the same Kaiser issue brief, Medicaid expansion has not negatively impacted labor market participation; in fact, some research demonstrates that Medicaid coverage supports work.
Finally, last year’s tax bill, which included a repeal of the ACA’s individual mandate, continues to wreak havoc on insurance premiums. The Congressional Budget Office (CBO) recently revised its estimates and determined that this repeal will lead to a premium increase of at least 10% in 2019. Premium increases are expected to be finalized state-by-state in early October, roughly a month prior to November’s general elections.