One Year of Policy Changes since the House Vote on ACA Repeal

Kaitlin Brown
May 4, 2018

One year ago today, 217 Republican Members of Congress voted to pass the American Health Care Act (AHCA) in the House of Representatives. This legislation essentially repealed the Affordable Care Act (ACA), and could have left 20 million people without access to quality, affordable health insurance. Thanks to the hard work of healthcare advocates, the bill was stopped in the Senate after two more months of debate and votes. Just because the bill failed, however, does not mean threats to affordable healthcare have ended. In the past year since the failure of the AHCA, the Trump administration has worked through many different channels to try to actively sabotage the success of the Affordable Care Act.

Already, we are seeing the effects of this sabotage on the uninsured rate and cost of premiums in the United States. A new study by the Commonwealth Fund, estimates that 15.5% of adults are uninsured, which is about three percent higher than in 2016. This “death by a thousand cuts” effort by the administration means that an additional four million people are already without insurance. The uninsured rate is only expected to go up as premiums increase and people are priced out of the individual market.

Below is a step-by-step analysis of the steps the administration has made to take affordable healthcare away from millions of Americans:

June 8, 2017: In a Senate Budget Committee hearing on June 8th, then-Health and Human Services Secretary Tom Price would not answer if the Trump administration would allow cost-sharing reduction (CSR) payments, leading to an uncertainty for insurance companies, and ultimately higher rates. Cost-sharing reduction payments are a key part of making sure that health insurance premiums stay affordable for consumers. Insurance companies need set their rates about a year in advance, and need to know if they will be given cost-sharing reduction payments or not to keep premiums affordable.

July 20, 2017: The Department of Health and Human Services begins a public campaign against the ACA through promoting a videos series of people harmed by the Affordable Care Act, tweets, and removing information about the ACA’s provisions from its website.

July 29, 2017: The American Health Care Act (AHCA) fails in the Senate. President Trump tweets that he will not make CSR payments any longer if the bill is not passed, causing more uncertainty for insurance companies.

August 31, 2017: The Trump administration cuts the advertising budget for the individual marketplace by 90%.

September 22, 2017: The Centers for Medicare and Medicaid Services (CMS) announces that, the website where many people sign up for health coverage, will be unavailable most Sundays of the open enrollment period. This is a key time for many faith-based groups who help people enroll after church services.

October 12, 2017: In a move that could leave one million people uninsured by 2018, the Trump Administration decides to end CSR payments.

December 22, 2017: As a provision of the recently passed tax bill, the ending of the individual mandate is signed into law. This could cause thirteen million people to not have insurance, as well as raise premiums by 10% due to a lack of younger, healthier people in the individual marketplace.

January 12, 2018: CMS announces that it will approve Kentucky’s request to institute work requirements within the Medicaid program. This will cause low-income people who are unable to meet or document the new requirements to lose coverage.

February 1, 2018: Indiana’s Medicaid Work Requirement waiver is approved.

February 20, 2018: CMS proposes a rule that would allow short-term health insurance plans to be used for a year. These plans do not need to meet the standards set by the Affordable Care Act, and do not need to cover benefits including: maternity care, mental health services, pharmacy services, and more. They also are not required to cover people with pre-existing conditions. In addition to harming people who use the plan as long-term insurance, this would continue to draw young, healthy people away from the individual marketplace.

March 5, 2018: Arkansas’ Medicaid Work Requirement waiver is approved.

April 9, 2018: CMS announces a rule that makes it harder for consumers to learn about different healthcare plans, as well as loosens the standards of coverage that had previously been in place by the Affordable Care Act.

This is just a small sample of the actions that the Trump administration has taken to take healthcare away from millions of people. The Center for Budget and Policy Priorities has an exhaustive list of every action that the administration has done in the past year to try and undermine the success of the ACA.

What the Trump administration has not been able to accomplish through the legislative process, they have moved to doing through executive actions. These harmful actions have already caused four million people to be without coverage, and will continue to affect millions more as premiums increase. Others will be stuck in short-term insurance plans that do not provide adequate coverage, and could be liable for thousands of dollars in healthcare bills in an emergency setting. NETWORK will continue to resist the Trump administration’s continued attacks on the healthcare of our sisters and brothers.