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« Protect Medicaid to protect women and families! | Main | Celebrate ACA advances for women’s health! »
Thursday
Mar282019

Trump’s ACA shocker; Pelosi’s ACA rescue plan

Health care back at center of national stage

Two diametrically opposed approaches to health care were on display this week. On Monday, the Trump administration shocked legal observers—and even members of the GOP—by announcing that it would not defend any part of the Affordable Care Act (ACA) in court. On Tuesday, House Democrats unveiled sweeping new legislation to significantly expand and improve upon the ACA.  Then on Wednesday, a federal judge struck down a core part of the administration’s attacks on Medicaid, its promotion of work requirements.

On Monday, the Trump Justice Department announced that it is no longer asking the courts to uphold any part of the ACA in the Texas lawsuit challenging the constitutionality of the health care law.  Previously, the Trump administration had surprised legal observers by declining to defend the ACA’s protections for people with pre-existing conditions, even as it defended the rest of the law. (The department’s refusal to fully defend the law was so controversial that several Justice attorneys ultimately removed themselves from the case.) 
 
Then in December, federal court Judge Reed O’Connor (hand-picked by the GOP plaintiffs) issued a ruling to overturn the entire ACA that was so shocking even prominent conservatives called it “bananas” and “an exercise of raw judicial power.” Now, under DOJ’s new filing, the administration has abandoned its previous position without explanation, arguing that O’Connor’s decision striking down the entire law should be upheld by the Fifth Circuit Court of Appeals.
 
Behind-the-scenes reporting makes clear that the White House is attempting a cynical, if politically dubious, ploy to force Democrats to support a Trumpcare alternative by blowing up the current system. But University of Michigan law professor and former Justice official Nicholas Bagley points out that it’s actually far more sinister.
 
Calling the move “far beyond the pale” and a “serious threat to the rule of law,” he writes: “The duty [to defend the law] is a close cousin to the president’s constitutional duty to enforce the law. If the Justice Department really thinks that Obamacare is so blatantly unconstitutional that it can’t be defended, that implies that the president is violating the Constitution whenever he applies it. It’s not hard to see that as an incipient justification for refusing to enforce any law that the president believes to be unconstitutional, however ridiculous or partisan that belief might be.”
 
While the case is still considered a long-shot despite the Trump administration’s new stance, it’s worth considering what’s at stake if the ACA is overturned. More than 12 million people who gained coverage through the ACA’s Medicaid expansion would immediately lose their care. Another 9.2 million people who receive federal subsidies to buy insurance through ACA marketplaces could find their care unaffordable without help. An estimated 133 million Americans have pre-existing conditions that could disqualify them from buying health insurance if the law falls, 171 million people could see annual and lifetime caps on coverage return, 60 million Medicare recipients would face higher costs, and 2 million young people currently on their parents’ health plans could be kicked off of coverage.

Women live in poverty at higher rates than men do, live longer than men, and are much less likely than men to have employer-provided insurance in their own names, making them particularly vulnerable to attacks on Medicaid, Medicare, and the ACA. At the same time, all of the law’s protections against discrimination and benefits for women—including contraceptive coverage, maternity care, breastfeeding support, well-woman visits and more—would fall. 
 
Downplaying these real-world harms, Trump told reporters, “If the Supreme Court rules that Obamacare is out, we’ll have a plan that is far better than Obamacare,” he said. Despite making similar promises during the campaign, the Trump White House has never put out its own health care plan and has no realistic path forward.

Pelosi and House Dems propose plan to expand, improve on the ACA

While congressional Republicans groused anonymously about the possibility of ripping health care away from 21 million Americans and affecting millions more without any idea of how to help them, House Democrats, led by Speaker Nancy Pelosi, put on a united front on Tuesday in rolling out sweeping new legislation to significantly expand and improve upon the ACA.

The new bill would unwind Trump administration sabotage of the ACA by blocking “junk” health plans and other Trump-exploited loopholes that circumvent protections for people with pre-existing conditions. It would also end Trump efforts to weaken the ACA’s essential health benefit coverage requirements and would restore funding outreach for open enrollment, among other steps. It would also fix long-standing problems with the current law, like eliminating the “family glitch,” which bases affordability on an individual’s premiums even when the family needs coverage.
 
But most importantly, the bill comes closer to fulfilling the promise of the ACA by making coverage far more affordable for working and middle class families. The bill takes important steps that we have long called for, such as making existing financial assistance much more generous for people with incomes below 400 percent of the federal poverty level (FPL) and eliminating the current cap on assistance for people with incomes above that threshold.
 
For middle class families with incomes above 400 percent FPL, the bill would make them eligible for premium support if the premiums for the benchmark plans in their area would cost more than 8.5 percent of their incomes. For example, a typical 60-year-old making $50,000 would see her premiums cut significantly. Where she now pays a monthly premium of $1,016, she would pay $354 per month under the new bill, or 8.5 percent of income. All together, the bill would lower premiums for 13 million people and extend coverage to millions more who are currently uninsured.
 
The lead sponsor of the House’s Medicare for All bill, Rep. Pramila Jayapal (D-WA), told reporters that “We are completely united, as I’ve said for a while, on shoring up the ACA” even as their long-term goal is moving to a single payer system.

Judge throws out Medicaid work requirements in KY, AR

In a huge win for health care, on Wednesday, a federal district court judge threw out Medicaid work requirements in Kentucky and Arkansas, arguing that they violate the law. The Trump administration has encouraged states to seek waivers to Medicaid’s existing coverage rules in order to impose a host of new bureaucratic obstacles designed to block eligible people from getting covered through the program. Thus far, Arizona, Indiana, Michigan, New Hampshire, Ohio and Wisconsin have been given approval by the administration to start imposing work requirements, and several others have sought or are weighing approval.

As we wrote last year, the Medicaid statute is clear: waivers must help improve access to care and any waiver that seeks to block coverage is in violation of the law. Judge James E. Boasberg agreed, writing “The Court cannot concur that the Medicaid Act leaves the [HHS] Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose.”

In April, we will be focusing on the Medicaid program, what it means for women, and what these bureaucratic red tape requirements are really intended to do. Stay tuned!

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