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Why the New ACA Waivers Matter

by Axios | 10.23.18

As in-the-weeds as a revised waiver process sounds, the practical effects of what the Trump administration announced yesterday could add up to one of its most substantive blows yet against the Affordable Care Act.

The big picture: These changes will likely cause more separation of healthy and sick people, but only in states that avail themselves of these new options — creating another level of segmentation between red and blue states.

How it works: Under the Obama administration, states seeking a waiver from the ACA’s rules had to show that their alternatives would cover just as many people as the ACA, with insurance that’s just as robust, for the same cost. That’s why only 8 waivers have ever been granted.

  • But under the Trump administration’s approach, if the same number of people have access to ACA-level coverage, that’ll count — even if few of them actually choose it.
  • Likewise, “a waiver that makes coverage much more affordable for some people and only slightly more costly for a larger number of people would likely meet” the new standards, the formal policy guidance says.
  • States could, for example, seek a waiver that would let their residents apply the ACA’s premium subsidies to “short-term” insurance plans, even though those plans don’t meet the ACA’s requirements, including the mandate to cover people with pre-existing conditions.

Between the lines: The Trump administration has often treated the ACA’s exchanges as a de facto high-risk pool. And that’s the best prism through which to understand these latest changes.

  • These waivers will let states lean even further into new, non-ACA options for healthy people. That will likely increase premiums for ACA coverage. But because the vast majority of ACA enrollees are subsidized, they’ll be insulated from those costs.

There are limits to how far that dynamic can go, because states' waivers still can’t add too much to the federal government’s costs. But that’s the basic dynamic at play here — and it’s one that will continue to move the larger individual market further and further away from the ACA.

Sam Baker

Photo: Joe Raedle/Getty Images

Axios

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(26)
  • Chickie
    10/23/2018
    ···

    #45 is routing ACA and allowing insurance companies to call the shots. To those in Congress and the Senate, your constituents have let y’all know many times over, not covering preexisting conditions will leave countless millions of Americans without health insurance coverage and without pharmaceutical coverage, due to high costs. Step Up and Speak Up! Represent your constituents ~ not the health insurance or pharmaceutical companies.

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  • Kodiwodi
    10/23/2018
    ···

    Trump never misses an opportunity to make the poor poorer or the sick sicker.

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  • Robert j.
    10/23/2018
    ···

    We could use more Congressional guidance on this matter of healthcare reform. How about a 2019 bill to codify healthcare as a citizen right to access. No insurance? Take Medicaid or Medicare. States without Medicaid can do Medicare. Ok with everyone?

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  • ArtyK
    10/23/2018
    ···

    We need a single payor system already. Our leaders need to care about our health. It’s horrible to get sick and have such financial pressure or ruination. Come on already. Do the right thing.

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  • John
    10/23/2018
    ···

    Stop 45! Universal single payer healthcare, cradle to grave.

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  • IllWill
    10/23/2018
    ···

    This administration is slowly gutting the ACA to the point where it is no longer effective anymore. As a result, 3 million people lost their health insurance during Trump’s first year and many more will in the future. This criminal President is endangering the health of our country.

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  • Christopher
    10/24/2018
    ···

    This decision will undermine the future of the ACA and healthcare for millions of Americans who otherwise not have insurance. With no offsetting option for these citizens the future of their care is uncertain.

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  • Science-Truth-Under-Attack
    10/23/2018
    ···

    We can't let the republicans sink our healthcare although they continue to try. You lost leadership in the house and senate over voting for the affordable care act, please stand up for it now.

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  • Linda
    10/23/2018
    ···

    This is another attack on the ACA & our health care. It allows insurance companies to sell bad insurance policies that don't cover anything & don't protect pre-existing conditions. These are terrible policies.

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  • Brian
    10/23/2018
    ···

    The more waivers we allow to comprehensive health insurance plans which cover pre-existing conditions, mental health coverage, and other things used to be considered "extra", the more we continue to weaken the marketplace and allow people to slip through the cracks...only to burden the system later when they need services. I understand why people didn't want to feel "forced" to buy extra services they're not using, but that's how our healthcare industry is set up. If we don't like "forcing" people to buy comprehensive coverage to help them be healthier and not burden the rest of us, then we need to completely overhaul the system with a single-payer approach or shut down health insurance altogether. You can't have it both ways and be successful.

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  • Margarita
    10/24/2018
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    Enough of this - time for Medicare for all is long overdue.

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  • Sean
    10/24/2018
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    Universal comprehensive coverage is the only way to keep cost low Vote all Blue

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  • J
    10/24/2018
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    The Republicans want to scam the people into worthless health insurance. They’re worse than used car salesmen.

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  • Linda
    10/24/2018
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    This ia another attack on our health care. These waivers will allow insurance companies to sell junk policies that won't cover anything. It will also take pre-existing conditions protect away. Stop attacking our health care.

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  • John
    10/23/2018
    ···

    Stop 45! Universal single payer healthcare, cradle to grave.

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  • Seamusman
    10/24/2018
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    Stop Trump

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  • Joel
    10/24/2018
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    My health care, Social Security and Medicare, that I have paid for for decades are my concern. Take care of your constituents.

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  • A david
    10/24/2018
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    The greatest driver on single payer health insurance is the GOPs efforts to eliminate affordable health care.

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  • Darby
    10/24/2018
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    I want to see a new healthcare bill in the next 2 years! I want to see pre-existing conditions and parents healthcare until 26 years old in the final plan. I want to see affordable healthcare for all, but not to the point where it is hurting hospitals. Through ACA hospitals are only given a small fraction of what they charge their patients which is really sad because they are not going to be able to stay open without money. People are losing jobs because of these cuts in funds.

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  • Tom
    10/25/2018
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    The ACA is a failure, Middle Class cannot afford the costs, and when two or three choices of Insurance companies for an intire State, sorry ACA does not work Medicare for all will strip all the elderly who receive it now from receiving Medicare.

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