Since the Affordable Care Act (ACA) become law in 2010, Congressional Republicans have vowed to repeal and replace it. With the advent of the Trump Administration in 2017, they were in a more favorable position to send a bill to the White House to be signed for that purpose. The problem is that they failed to pass the necessary legislation. Until they are successful in doing so, which appears highly unlikely, another option is for the Administration to issue rules that make it possible for different kinds of insurance products to enter the marketplace for consumers. Association health plans and short-term plans are examples.

A separate remedy to pursue is to use the courts. A way to do so is to claim that certain provisions of the ACA are unconstitutional. The Department of Justice (DOJ) has declined to defend the provision of the ACA that protects individuals with pre-existing conditions from being declined individual health insurance protection. If a judge rules in favor of 20 Republican states currently suing the federal government over the constitutionality of the ACA, possible outcomes could include: increased charges for women, individuals with health problems could lose their coverage, and young beneficiaries could pay lower premiums.

Final Rule Issued On Association Health Plans
The Department of Labor on June 19, 2018 issued a final rule aimed at making it easier for small businesses and individuals to create association health plans (AHPs), which are entities that will be exempt from certain Affordable Care Act (ACA) consumer protection requirements. The rule exempts AHPs from individual and small group market regulations, allowing AHPs to offer less comprehensive insurance products. Small groups will have an opportunity to combine to purchase health insurance that does not have to comply with essential health benefit (EHB) standards. Small businesses and self-employed individuals in the same industry, state, or region will be able to obtain health coverage as if they were a single large employer. These new plans will become effective on September 1 of this year. Although Democrats are not in favor of this approach, Republicans assert that more coverage options and affordable alternatives will be available than was possible under the Affordable Care Act. The Congressional Budget Office (CBO) estimates that four million individuals will join the new AHPs. If enrollees prove to be healthier and have higher incomes, premiums for individuals remaining in the ACA individual marketplace may become higher.

Proposed Creation Of Short-Term Health Insurance Plans
The Trump Administration has indicated that another rule soon may be issued regarding short-term health plans, which also will not include various ACA requirements. This kind of coverage is designed to be less comprehensive and less expensive than what is available in the Affordable Care Act (ACA) marketplaces. A main feature is that insurers would be able to sell them for up to 12 months, potentially making them more attractive, especially to younger and healthier individuals. Researchers from RAND did an examination of how the rule may affect insurance enrollment and premiums, analyzing the rule alone and in combination with the recent repeal of the ACA individual mandate penalty, which occurred with tax reform legislation that became law last December. Changing only the duration of short-term plans would have minimal effects, but increasing the duration to 12 months, removing the individual mandate penalty, and eliminating some behavioral barriers (e.g., increasing awareness of short-term plans) would decrease enrollment in ACA-compliant plans by nine million and increase premiums in silver-tier marketplace plans by 3.6%.

Medicaid Overpayments
When the ACA became law, Medicaid became a principal vehicle for providing insurance coverage for individuals who lacked it. Republicans on the Senate Homeland Security and Governmental Affairs Committee released a report on June 20, 2018 accusing the Centers for Medicare and Medicaid Services (CMS) of not conducting adequate oversight of the Medicaid program. Their report indicates that Medicaid overpayments have increased from $14.4 billion in 2013 to $37 billion in 2017.

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