In the Health Reform Update for this week, Republican leaders pledge to move forward in March with a bill to repeal and replace key parts the Affordable Care Act (ACA), even though leaked proposals lack enough support to pass the House or Senate. The latest plans would provide fewer premium and cost-sharing subsidies, replace the Medicaid expansion with capped block grants, and return to the pre-ACA landscape of high-risk pools and insurer discrimination against those lacking continuous coverage.
A federal court complicates repeal efforts by requiring the Trump Administration to pay all outstanding amounts owed to insurers under the ACA’s risk corridor program that provided extra compensation for exceptional claims. After Humana becomes the first major insurer to exit all ACA Marketplaces for 2018, the Administration gives insurers seven additional weeks to decide whether to participate. It also extends transitional or ACA-deficient plans for an additional year while directing the Internal Revenue Service not to enforce the individual mandate penalty on those who simply refuse to disclose if they are uninsured.
Despite higher than expected enrollment among the 12 state-based ACA Marketplaces, total sign-ups fall four percent below 2016 figures after the open enrollment period. Maine voters will get to decide on Medicaid expansion this fall after six vetoes from their Republican governor. Arkansas lawmakers attempt to freeze Medicaid expansion despite protests from their Republican governor, while House Republicans in Kansas pass a hospital-backed expansion plan by a surprisingly-wide margin.