Affordable Care Act remains ‘law of the land,’ but Trump vows to explode it

Although House Speaker Paul D. Ryan (R-Wis.) acknowledged Friday that “Obamacare is the law of the land,” its survival or collapse in practical terms now rests with decisions that are in President Trump’s hands. In the coming weeks and months, the White House and a highly conservative health and human services secretary will be faced with a series of choices over whether to shore up insurance marketplaces created under the Affordable Care Act — or let them atrophy. These marketplaces are currently a conduit to health coverage for 10 million Americans, but they have been financially fragile, prompting spiking rates and defections of major insurers.

There are many levers within the ACA that the administration could use to undermine the law or, instead, try to stabilize its marketplaces. In addition, federal rules could be redefined, giving the government’s health policies a more conservative twist even with the law still in effect.

Trump’s threat could become “a self-fulfilling prophecy,” said Andy M. Slavitt, the acting administrator of the federal Centers for Medicare and Medicaid Services for the last two years of the Obama administration. “That’s like inheriting an overseas war, and deciding you let your own soldiers get killed because you didn’t elect to enter that war.”

The decisions facing the administration are, in essence, a sequel to an executive order the president issued his first night in office, when he directed federal agencies to ease the regulatory burden that the ACA has placed on consumers, the health-care industry and health-care providers. So far, the main action stemming from that directive is a move by the Internal Revenue Service to process Americans’ tax refunds even if they fail to submit proof that they are insured, as the ACA requires.

But there are other steps the administration could take. A major one would be to end cost-sharing subsidies the law provides to lower- and middle-income people with marketplace plans to help pay their deductibles and co-pays. Those subsidies, which would have been erased by the House Republicans’ bill, are the subject of a federal lawsuit.

Another question is how the administration will handle the next enrollment season for ACA health plans, which will begin in November. The end of the most recent season coincided with Trump’s first days in office, and the new administration yanked some advertising meant to encourage sign-ups — possibly resulting in a small dip in enrollment by the final deadline.

And while a set of federal essential health benefits, required of health plans sold to individuals and small businesses, will now remain in law, federal health officials could narrow what they require, limiting prescription drugs, for instance, or the number of visits allowed for mental-health treatment or physical therapy.

(Excerpted from Washington Post 3/24/17)