Despite an agreement by Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) on modest bipartisan changes to the ACA, the Trump Administration and Republican leaders have been taking aggressive action to undercut coverage and success. The President, HHS leaders, Senator Orrin Hatch (R-UT), and Congressman Kevin Brady (R-TX) were acting to aggressively undercut the law.

All of this action comes against a new CBO estimate that says the Alexander-Murray bill would reduce the deficit through 2027 by $4 billion and would not reduce insurance coverage unlike previous bills. The Alexander deal, worked on for several weeks, would extend for two years the Cost Sharing Reductions (CRS) subsidies the President has cut off, allow a more streamlined state waiver process, and expand the options for lower cost stripped down policies (copper plans). The CBO analysis compares to an earlier analysis that cutting off the CRS payments would increase the deficit by $194 billion by 2026. That is because the dropping of the payments drives up premiums and in turn pushes up tax credits to consumers by policies.

Despite those positive developments, the Administration and Republican leaders have taken several actions to weaken and undercut access and coverage in addition to cutting out the CRS subsidies. Included in recent actions:

• Reducing the advertising and outreach budget from $100 million to $10 million.
• Denying a Massachusetts an ACA waiver request.

• Stalling on waiver requests from Iowa and Oklahoma and causing those states to pull their requests.

• The President telling Senate Republicans at a caucus luncheon on Tuesday, October 24 that he wants them to focus on taxes and not on a health care bill.
• Introduction of a bill by Finance and Ways and Means Committee chairs Hatch and Brady of a partisan bill that is certain to draw opposition from Congressional Democrats.

The Administration cut in advertising and outreach during this November-December open enrollment period could reduce the number of insured in the country which is likely to put upward pressure on health care costs and premiums. In a Washington publication, Joshua Peck, the former head of marketing for, predicted the cut to outreach will reduce enrollment by over 1 million people: “the least harm the administration’s outreach cuts could have — this is a best case scenario.”

In Congress comments by Speaker Paul Ryan (R-WS) in opposition to the bipartisan deal were supplemented by the Hatch-Brady announcement of a bill that would repeal the individual and business mandates to buy/provide insurance, have abortion restriction language, and amend the tax code to expand health savings accounts.

In regard to state waivers, Massachusetts was denied a waiver allowed under the ACA, with HHS informing them their application was too late. Massachusetts had attempted to get a waiver that would allow them to set up a premium stabilization fund in lieu of cost-sharing reductions (CRS) subsidies that the President has announced he will not pay. The decision came just after the state of Iowa announced that it was withdrawing its waiver plan. Several weeks ago the Washington Post had reported that Iowa could not get an approval of their waiver after the President personally intervened against it within HHS. State officials denied that they had been turned down at the time of the Post report and instead said they were still working with the Administration. Oklahoma also withdrew their request at approximately the same time.

An analysis of insurance premiums for the 2018 season indicates they are realizing the impact of the presidential cut-off of payments along with other aggressive actions against the ACA. Iowa, which appears to be in the most trouble, will experience increases around 69 percent, with Utah and Wyoming seeing increases at 65 and 64 percent. Some states, however, are seeing decreases. Arizona, which made headlines a year ago at this time with an increase at over 140 percent, will experience a decrease of 6 percent, while North Dakota’s premiums will decrease by 4 percent, and Alaska, which has been granted a waiver for “reinsurance” that offsets the expenses for high-cost patients, is going to see a decrease of 22 percent. There is also some analysis that since the tax credits will go up as a result of the premium increases, it may make it more possible for customers to now purchase the more expensive and higher-coverage gold plans instead of the lower-coverage silver plans.