Getting Ready For Health Reform 2020: Republicans’ Options For Improving Upon The State Innovation Approach

By Lanhee Chen
HealthAffairs, Nov. 16, 2018

In 2020, the Republican presidential nominee will likely signal broad opposition to the ACA and a desire to replace it with a state innovation–based approach to reform, based on the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in the fall of 2017. This article takes that legislation as a starting point, contextualizes it within the broader health reform discussion, and suggests ways to improve upon it to enhance the affordability of and access to coverage and to ensure that states have adequate flexibility to implement their policy goals.

A Judge Will Likely Rule Against Obamacare. Here’s What Should Happen Next.

By Doug Badger
The Daily Signal, Nov. 20, 2018

A federal judge is expected to rule soon on whether Obamacare’s individual mandate is constitutional without a tax penalty to enforce it, and if it is not, whether the rest of Obamacare’s provisions (including its insurance regulations) are no longer operative. Even if the high court were to strike down the federal rules, states would retain the authority to regulate health insurance. Policymakers should not panic with hasty legislation. States would be free to explore other ideas to protect people who have pre-existing conditions without pricing health insurance out of the reach of those who don’t and could pursue innovative regulatory approaches to improve their insurance markets.

Trump Administration Details Health-Law Waivers for States

By Stephanie Armour
The Wall Street Journal, Nov. 29, 2018

The Trump administration on Thursday released four model waiver ideas states can use under its new-and-improved Section 1332 guidance to give them more flexibility to lower premiums and increase choices in their health insurance markets. The templates suggest ways states could use waivers to restructure ACA premium subsidies that now go to almost nine million people. As examples, states can develop a new premium subsidy structure and decide how those premium subsidies should be targeted; they can set the rules for what type of health plan is eligible for state premium subsidies to give people access to more health plan options; and states can implement risk stabilization strategies to address the costs of high risk individuals to reduce premiums in the market for everyone.

The False Promise of ‘Medicare for All’

By Scott Atlas
The Wall Street Journal, Nov. 12, 2018

Nationwide “Medicare for all” would cost more than $32 trillion over its first decade. Doubling federal income and corporate taxes wouldn’t be enough to pay for it. No doubt, that cost would be used to justify further restrictions on health care access. But the problems with single-payer go well beyond cost. In the past half-century, nationalized programs have consistently failed to provide timely, high-quality medical care compared with the U.S. system. That failure has countless consequences for citizens: pain, suffering and death, permanent disability, and forgone wages.

Rescinding Obama-Era Guidance on ACA Waivers Invites States Back to the Reform Table

By Rea Hederman
The Hill, Nov. 2, 2018

President Trump’s Department of Health and Human Services recently announced welcome new guidance to states looking to improve their health care and health insurance systems through “state innovation waivers” under Section 1332 of the ACA. The new guidance gives states significantly more flexibility to devise creative solutions to meet the health care and insurance needs of their constituents, and it builds upon new community engagement waivers that made Medicaid more flexible for states earlier this year. Section 1332 allows states to experiment and creatively tailor their health care coverage programs under certain conditions.

Trump is making Obamacare optional

By Ryan Ellis
Washington Examiner, October 26, 2018

The Trump administration has been hard at work doing what it can to give families more and better healthcare choices than what Obamacare saddled them with. In so doing, the administration has created several welcome escape hatches from Obamacare. From giving employees more flexibility in how they obtain health coverage, to Association Health Plans, less-expensive short-term plans for bridge coverage, and giving states the flexibility to tailor ACA spending more to their citizens’ needs, the Trump administration’s “Obamacare Optional” agenda of more choices and more affordable healthcare is a very robust one.

Short-Term Plans: Affordable Health Care Options for Millions of Americans

By Jonathan Ingram
Foundation for Government Accountability, Oct. 30, 2018

In August 2018, the Trump administration finalized a rule to strengthen short-term plans by allowing individuals to keep them for a period of up to 364 days (and renew them for up to three years). The new rule is one of several strategies the Trump administration has pursued to offer more affordable options to millions of Americans who were priced out of the insurance market by skyrocketing premiums. New research from the Foundation for Government Accountability finds that for the average monthly premium for a 40-year-old non-smoking female, short-term plans would be 59% less expensive than individual market plans. For the same patient, there would be eight times as many short-term plans available.

Trump Administration Loosens Restrictions on Obamacare Waivers

By Nathaniel Weixel
The Hill, Oct. 22, 2018

In another action, the Trump administration issued new guidance that loosens restrictions states face in trying to lower costs and increase affordable options for health insurance. The guidance replaces strict ObamaCare requirements that severely limited state flexibility. The new guidance allows states more leeway in using Obamacare resources to shore up their individual and small-group health insurance markets. As Doug Badger has demonstrated, when states are given even a small amount of flexibility, they can provide better support for patients with high health costs and make coverage more affordable for healthier individuals and families being shut out of the market because of costs.

New Health Options for Small-Business Employees

By Secretaries Acosta, Mnuchin and Azar
The Wall Street Journal, Oct. 23, 2018

The Trump administration is proposing a regulation that would create a new vehicle for employers, especially small firms, to provide health coverage for their employees. The proposed rule would allow employers to reimburse employees for health insurance they purchase on their own—including short-term, limited-duration plans that are more flexible than ACA plans or pooling funds with a spouse to purchase a family plan. Employers can provide a defined contribution to employees that carries the same tax advantages as employer-sponsored health insurance. It also would allow employers that offer a traditional group plan to also offer a Health Reimbursement Arrangement of up to $1,800 a year to reimburse an employee for certain qualified medical expenses such as stand-alone dental benefits.

When Does the ‘Affordable’ in the Affordable Care Act Kick In?

By Merrill Matthews
The Hill, Oct. 14, 2018

The Kaiser Family Foundation just released its annual survey of employer-sponsored coverage, finding that the average premium for family coverage increased 5% to $19,616. To put that in perspective, the real median household income in 2017 was $61,372. Thus family health coverage costs nearly a third of the median family’s income. Since 2008, annual deductibles for covered workers have increased 212%—eight times the rate of inflation. And to think Democrats used to call high deductible coverage “junk insurance.” Yet, under ObamaCare deductibles have exploded.