In a span of less than 24 hours this past week, the Trump administration took two seemingly contradictory actions that could have profound effects on the insurance marketplaces set up by the Affordable Care Act.
Health analysts say that at least one of the efforts, coupled with previous changes initiated by the administration, could help transform the insurance market to be much more like it was before the 2010 federal health law took effect — when regulation, coverage and consumer protections varied widely across the United States.
The week’s first move came on Monday morning, when Trump’s health officials issued guidance that could undercut the exchanges set up for people who buy their own health insurance. The administration’s guidance makes it easier for states to get around some ACA requirements, Trump’s guidance would allow the use of federal subsidies for skimpier plans that can reject people who have pre-existing medical conditions.
By the next day, the administration had made a second move with a proposed rule that could bolster the health of the ACA marketplaces by sending millions of people who now have job-based coverage into the exchanges, armed with tax-free money from their employers to buy individual plans.
Both efforts play into the parallel narratives — one from Republicans and the other from Democrats — that aredominating the parties’ bitter political debate over the ACA, also known as Obamacare.
Frustrated that a Republican-controlled Congress has been unable to repeal the Affordable Care Act outright, the Trump administration has continued to work to undermine that law by weakening the marketplaces and the law’s consumer protections, some critics and health policy specialists say.
Trump’s efforts make it easier for insurers to offer skimpier policies that bypass the law’s rules, such as protections for people with pre-existing conditions or a ban on annual or lifetime limits on what insurers will pay.