States and Trump Administration Push to Roll Back Health Care Gains


The Trump administration’s repeated dismissal of some of the most important provisions of the Affordable Care Act (ACA) – such as its protections for individuals with pre-existing conditions and its requirement for insurers to cover Essential Health Benefits – has been evident for some time. Now a Government Accountability Office (GAO) report places much of the blame for the dip in ACA enrollment last year at the feet of the administration.

8.7 million Americans enrolled in health insurance plans offered through the ACA’s individual health insurance marketplace in 2018, a five percent decline from the 9.2 million who enrolled in plans in 2017. The report attributes much of this decline to the administration’s failure to set enrollment targets, reduction in funding for outreach and enrollment, confusing messaging, and chaotic policy decisions – including the decision to end cost-sharing reduction payments.

ANA joined with other patient and provider groups in an attempt to fill some of this gap through its own Open Enrollment advocacy and outreach campaign in late 2017, which resulted in more than 40,000 visits to as well as local and national media visibility. GAO recommended that the administration set enrollment targets for 2019 to alleviate this decline, though given the administration’s repeated sabotage of the law – including its work with Congress to try to repeal it – this seems highly unlikely to happen.

Regardless of what happens at the federal level, states are still attempting to implement policies that erode access to quality, affordable health care. Three states (Arkansas, Indiana, and New Hampshire) have implemented CMS-approved 1115 Medicaid waivers that impose work requirements on certain adult Medicaid beneficiaries (Kentucky’s work requirements policy was recently invalidated in federal court). Several other states, such as Ohio, have pending 1115 Medicaid waivers that would allow them to impose work requirements on certain adult Medicaid beneficiaries.

Worryingly, some states such as Mississippi – which hasn’t expanded Medicaid – have also applied for waivers to impose work requirements, which would greatly restrict access to care for some of the most vulnerable Americans. And Tennessee has submitted a waiver request to the administration that would bar Planned Parenthood from participating in its Medicaid program – and in the process prevent hundreds of thousands of Tennessee residents from accessing critical health care services. All of these restrictive proposals, of course, require federal approval, which the Trump administration seems to be strongly inclined to grant.

ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. These recent moves by both the Trump administration and state governments fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services.

Healthcare stands to be a major issue in the 2018 midterm elections – 22 percent of respondents to a June 2018 NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. These elections in November are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. We urge you to make nursing’s voice heard loud and clear by supporting candidates who align with ANA’s principles for health system transformation and who are proven to be advocates for nurses and their patients!

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