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« Health care was the winning issue! | Main | It’s almost time for open enrollment in ACA coverage! »

ACA enrollment starts today; sabotage continues

Open Enrollment starts TODAY!

Today, November 1, is the first day of 2018 Open Enrollment season! Despite repeated attempts by Trump and the GOP to undermine or repeal the ACA, including a 90% cut to open enrollment advertising, Open Enrollment begins with great news for consumers. Premiums are stabilizing or even dropping, and most people have more options than before.
Open Enrollment only lasts 6 weeks in most states, so don’t wait to sign up! You can go to to explore your options, and find free enrollment assistance near you at If you would like to help us spread the word about Open Enrollment and help more people get covered, you can learn more about our outreach resources here

Another attempt to sabotage the ACA

In the closing weeks before the election, the Trump administration has done everything it can to change the message away from the GOP’s disastrous health care proposals. The president casually floated the idea of overturning the 14th amendment by executive order—he can’t. And GOP candidates around the nation have been trying to convince voters that they don’t support repealing protections for pre-existing conditions—they do.
Citing a number of Republican House members who’ve made false claims about their support for health care using an unrelated Washington Post fact-check, the Post wrote: “These lawmakers have been put on notice that they are peddling a falsehood—and politicians who care about their reputation should acknowledge they made a mistake and offer an apology. Instead, they apparently believe it is politically advantageous to continue to deceive the voters in their districts.”
But while the public’s attention has been on the election, the administration has been diligently working to gut those same protections through executive action. Last week, the administration issued new guidelines that will allow states to effectively eliminate the Affordable Care Act’s consumer protections through the 1332 waiver process.
Under section 1332 of the ACA, states may apply to waive some of the law’s requirements in order to explore innovative alternatives for providing the same level of coverage. The law establishes certain guardrails to ensure that a comparable number of people are covered with the same quality of care at no additional cost to the federal government. Guidance issued by the Obama administration emphasized coverage for low-income and vulnerable populations.
Most of the waivers granted since 2015 have established state reinsurance programs. For example, Consumer Health First—Raising Women’s Voices Regional Coordinator in Maryland—helped successfully shepherd that state’s 1332 waiver for reinsurance. More radical proposals have been rejected.
But the guidance issued by the Trump administration is specifically intended to push states into promoting non-ACA compliant plans like Association Health Plans and short-term“junk” plans, driving up costs for those who remain in comprehensive ACA marketplaces. Using the same semantic sleight of hand that Republican leaders used for their repeal efforts last year, the new guidance emphasizes “access” to coverage over actual coverage.
Last year we warned you about the real-world impact of the Cruz amendment to undermine protections for pre-existing conditions: “the choice Cruz is offering is between insurance you don't want (the skimpy plans) and insurance you won’t be able to afford (the comprehensive plans, which will cost much more than they do now). … Even the insurance companies think the Cruz amendment is a bad idea! AHIP, an insurance industry trade group, says it would ‘de-stabilize the individual market and increase costs for those with pre-existing conditions.’”
Now, writing in the Commonwealth Fund, Timothy Jost warns that the new guidance is worse: “With its 1332 waiver guidance, the Trump administration is attempting to accomplish through administrative fiat changes in the ACA that Republicans repeatedly tried and failed to bring about through legislation in 2017. The waiver guidance, for example, resembles but goes even further than the Cruz Amendment to the Senate’s Better Care Reconciliation Act or the Graham-Cassidy-Heller-Johnson bill, which would have allowed coverage that is not legal under the ACA and funneled money directly to the states to spend on their own health coverage priorities. Like those bills, the 1332 guidance promises to further exacerbate differences in coverage between red and blue states.” It’s clear that in states that take up Trump’s offer now, those with pre-existing conditions could find themselves quickly priced out of the coverage they need.
Furthermore, despite touting increased “flexibility” for states, that flexibility only runs in one direction. The guidance makes it more difficult for states to use 1332 waivers to create a public option or pursue a Medicaid buy-in program to allow residents with incomes above the threshold for Medicaid eligibility to use their ACA assistance to purchase Medicaid coverage instead of a private plan.
Unlike a proposed regulation, the guidance went into effect immediately upon being issued on October 22 and will be used to evaluate all new 1332 waiver requests. Outside of a legal challenge, there’s no way to stop the guidance from moving forward. But activists can and should share concerns with state officials about the ways in which these Trump waivers will result in worse coverage, higher costs, and harm to people with pre-existing conditions.

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