Just as more insurers and consumers were entering the ACA individual market and things seemed to be stabilizing, the Trump administration struck a new blow against the health-care sector over the weekend, cutting off the multi-billion dollar risk adjustment payments that compensate insurers for taking on sicker and more expensive patients.
The move is yet another attempt to knock out one of the legs of Obamacare — creating a scenario where insurance companies have to accept all patients regardless of their health status, but will not be financially supported in doing so. Insurers are already saying the decision will force them to set their premiums even higher in 2019 to make up for this uncertainty, which is likely to price more people out of the market.
The Trump administration claims it is obligated to suspend these payments because of a court ruling out of New Mexico questioning their legality, but there is reason to be skeptical. Health law experts are pointing out that the Trump administration has not suspended other policies that have been challenged in court, including the defunding of open enrollment outreach and the implementation of Medicaid work requirements.
Speaking of which, Kentucky is responding to a federal court ruling knocking down its Medicaid work requirements waiver by stripping all adults on its Medicaid expansion of their dental and vision coverage. Thanks to an alleged glitch in the state’s electronic records, the move is also hitting children, pregnant women, and adults with disabilities, who were supposed to be protected from the cuts but who now are appearing as ineligible for Medicaid in the system.
The groups that successfully sued Kentucky and the Trump administration are now challenging these cuts. In a letter to CMS, the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center accuse the state of slashing the benefits without going through the proper procedure, which would include a public comment period. The result, the groups say, is “great confusion and harm.”
More lawsuits are expected in three other states that received a green light from the Trump administration to implement Medicaid work requirements. All eyes are on Arkansas, the first state to implement the new rules, where thousands of low-income residents are now at risk of losing their insurance. Under the state’s rules, residents can only qualify for Medicaid by submitting proof online that they are working at least 80 hours per month — even though the state has the second-worst rate of internet access in the country. The results were predictable:
Despite these battles, advocates of expanding Medicaid are on the march in red and purple states. This past week, residents of both Idaho and Nebraska gathered enough signatures to put expansions on the ballot this November.
The popularity of Obamacare’s Medicaid expansion and the predicted political backlash to the Trump administration’s sabotage is one of the reasons Democrats are feeling confident about November’s midterms. For the first time since Obamacare was created, Democrats are set to spend more on ads about the ACA than their GOP counterparts.
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