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Thursday
Apr192018

Watch out! Stealth campaign to give us Trumpcare, after all!

New Trump administration rules threaten our health care
 
Having failed to pass Trumpcare through Congress last year because of widespread public opposition, the Trump administration has been steadily working to quietly implement it through rule changes issued by the Executive Branch. Last week, the administration finalized rules for the individual and small business marketplaces that significantly weaken core consumer protections under the Affordable Care Act.
 
Using an annual rules update -- known as the Notice of Benefit and Payment Parameters (NBPP) -- as the vehicle, the administration announced sweeping changes to everything from the 10 essential health benefits (EHBs) that health plans must cover to how much insurance companies can charge in premiums. 
 
EHBs such as maternity care, prescription drug coverage, hospitalization and mental health care are guaranteed under the Affordable Care Act (ACA).  But under the new rules, the administration is granting states significant leeway to determine which services are actually covered under each broad category of benefits. It’s not hard to imagine, for example, a state approving a plan with maternity care that only covers a few prenatal visits and screenings. Even more troubling, states can shift coverage between categories, skimping on, say, mental health care, while increasing coverage for physicians’ visits. States will have significant freedom to design coverage requirements that help politically powerful groups at the expense of marginalized groups.
 
What can you do? Start talking to your state officials now to make sure they aren’t considering harmful changes to your state’s current EHB standards. States have until July 2, 2018, to change what is known as the “benchmark” plan for 2020. The ACA created guidelines for EHBs, but left the specific details up to each state. The benchmark plan is the plan each state designates as the standard for EHBs. So, it’s important to act quickly to get a seat at the table, and speak out to make sure the process is robust, transparentand open to public input. In future RWV newsletters, we will be sharing more ideas about how to oppose state actions weakening coverage requirements.
 
As the Center on Budget and Policy Priorities notes, the new Trump rule could have an impact on health benefits at large employers, too. Under the ACA, insurance companies must limit how much a patient can be expected to pay out-of-pocket for essential health benefits and insurers are prohibited from imposing annual or lifetime limits on those benefits. By weakening EHB standards, the rule could mean even employees at large firms could find themselves subject to new limits on coverage or higher out-of-pocket expenses.
 
The new rule also expands on last year’s efforts to sabotage the open enrollment period by slashing support for in-person navigators to help people enroll. States could establish a single navigator per state (up until now it has been at least two), permit navigators to be based outside of the state and eliminate rules intended to ensure that navigators are offering help to groups that may not be able to navigate the marketplace on their own due to language barriers, lack of internet access or other factors.
 
The rule also makes it easier for insurers to raise premiums. Insurers will be able to raise rates up to 15% (instead of the current 10%) without being reviewed by a state insurance regulator first.  Moreover, health plans won’t have to spend as much of the premiums they collect on actually providing care. By loosening the medical loss ratio (MLR) provision, the administration will give insurers much more flexibility under the rule to raise premiums and spend the increase on executive salaries and bonuses and other administrative expenses.
 
Meanwhile, comments close next Monday on another proposed rule to gut the ACA, this time to radically expand so-called short-term health plans into full-year “junk” plans that offer only barebones coverage and discriminate against people with pre-existing conditions.
 
Under current law, short-term health insurance plans intended to cover very short gaps in coverage don’t have to comply with the ACA’s consumer protections. But under Obama-era regulations, they are limited to just three months. They also never satisfied the individual mandate requirements. Under the Trump proposal, these short-term “junk” plans could last 364 days, and of course, the individual mandate has been repealed starting 2019.
 
Much like the Trumpcare proposals pushed by the GOP Congress last year, these plans would not be required to cover the EHBs. They could discriminate against people with pre-existing conditions, charge limitless out-of-pocket expenses and reinstate annual and lifetime coverage caps. Unlike ACA-compliant policies, these “junk” plans would also not be subject to the MLR provision and so not required to spend a minimum percentage of our premiums on actually providing health care.
 
Because these “junk” plans cover so little, they’d cost very little too, appealing to younger, healthier people who don’t expect to get sick, have an accident, or need much insurance throughout the year. That would make the market for comprehensive coverage older and sicker, driving up premiums for everyone who needs the quality coverage of ACA-compliant plans.
 
You can make your voice heard by commenting on the proposed short-term ruleHERE before 5:00 EST on Monday, April 23, and tweeting at the administration using the hashtags #junkplans #trumpcare.
 
Some states moving to protect health consumers from Trump sabotage
 
Our Newark-based regional coordinator, New Jersey Citizen Action (NJCA), has been working to help insulate New Jersey’s insurance market and consumers from GOP attempts to undermine the ACA. Last Thursday, the New Jersey legislature passed two bills that would help preserve access to affordable health insurance for New Jerseyans. These bills now await Governor Phil Murphy’s signature.
 
One of the bills, S1877, would establish a state-level individual health insurance mandate in New Jersey. The federal individual mandate, which was repealed as part of the GOP tax plan, was put in place to make sure younger and healthier people were part of the insurance risk pool. Health insurance only works when both healthy people and sick people pay health insurance premiums. Having people who need less health care in the risk pool helps to cover the cost of care for sicker people. This keeps premiums down for everyone and keeps the market stable. A state-level individual mandate would ensure that both healthy and sick people can get affordable health coverage in New Jersey.
 
The second bill, S1878, would allow for the creation of a reinsurance program in New Jersey. In a previous newsletter, we described our Maryland regional coordinator’s work successfully advocating for a similar bill, which has subsequently been signed by Maryland Governor Larry Hogan. Reinsurance programs are designed to help insurance companies offset the costs of more expensive medical claims, without resorting to raising premiums on everyone.
 
NJCA is encouraging New Jerseyans to urge Governor Murphy to sign these bills without delay to help shield New Jersey from unaffordable health care premium increases. 
 
This week is a good time to realize what the tax bill  is doing
 
As they’re working to protect the ACA at the state level, NJCA is also raising awareness throughout the state about the terrible impact the GOP tax law will have on the health and economic security of New Jersey women and families. They’re reminding New Jerseyans that in addition to repealing the individual mandate – which the CBO estimated will lead to 13 million more uninsured Americans and premium increases of about 10% – the tax bill passed by Congressional Republicans in December gives huge tax cuts to the wealthy and large corporations, and increases the national debt by trillions of dollars. Now, Republicans are looking to pay for those tax cuts with deep cuts to Medicare, Medicaid, Social Security, and other programs women and families depend on.
 
On tax day, NJCA rallied outside the district office of Congressman Tom MacArthur (R-NJ 3) – the only New Jersey Congressman to vote yes on the GOP’s tax bill – to demand that he work to #RepealTheTrumpTax.
 
Speaking at the rally, NJCA Health Care Program Director Maura Collinsgru told the crowd: “They revoked and are not enforcing the requirement that people who can afford insurance, maintain it, and because of that, there is an estimate that more than 300,000 New Jerseyans will not have coverage by 2025 unless the state of New Jersey acts. As our uninsured increase, so too will the premiums for every family in New Jersey, whether they get their coverage through an employer or they pay themselves. After we have cut our uninsured rate in half and slowed the growth of health care cost in the last five year to record lows, Tom MacArthur’s yes vote has meant we are reversing all the progress [we have made].”

 

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