So what's up with our insurance?

seeker

Mon, Jan 23 2017, 8:59 pm

There was this whole long thread about Trump today and I was astonished to see that it was about something other than this.

First couple of days in office and already wrote an executive order canceling some stuff having to do with Obamacare without any warning (other than stump talk) or information or plans of how this is going to roll out. OK, the plans for how Obamacare was going to roll out in the first place were flawed, but at least they attempted some preparation. Like it or not, you had some advance warning of what to expect...some. But this is just...huh? Scratching Head

As of the last time I read a news report about it (granted, I hit news in the morning and Imamother at night, so it's possible something happened while I wasn't looking) nobody had any clue what was going on or what this executive order means in real life.

I am not on any particular political camp. I'm in the "be rational" party. I didn't care for either major candidate but I have nothing to protest, was ready to give him a chance, had some hopes this could go well. But I REALLY don't understand this... taking actions that are going to have some kind of wide range effect that nobody seems to actually know about? What does that even mean? Why would you even do it that way?

And more importantly - what does this mean for health care consumers even in the short run? Are insurance companies going to be allowed to suddenly start dropping people or programs? What about doctors and hospitals? Are things going to change from one day to another without anyone knowing or understanding?

I'm not panicking, just very confused at the lack of clarity here!

youngishbear

Mon, Jan 23 2017, 9:35 pm

https://fivethirtyeight.com/fe.....hing/

Trump’s Executive Order On Obamacare Means Everything And Does Nothing

JAN 21, 2017 AT 10:56 AM

Trump’s Executive Order On Obamacare Means Everything And Does Nothing

By Anna Maria Barry-Jester

As promised, on his first day in office, President Donald Trump took steps to undo the Affordable Care Act, former President Obama’s signature health care law. In one of his first executive orders, Trump pushed the secretary of Health and Human Services (HHS) and other federal agencies to begin weakening the law. The meaning of the executive order is both subtle and bold; on the one hand, it does very little because it doesn’t grant the administration any powers that it didn’t already have. On the other hand, it signals to the public that change is coming and lets employees at HHS know that they’d better be part of that change.

Section 2 of the order instructs the secretary of HHS to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay” parts of the law that would place a fiscal burden on states, individuals or health-care providers. Most of the provisions in the ACA can’t just be changed by HHS or the president; they require action from Congress or a lengthy period involving public comment. Which is why it’s reasonable to assume this line is targeted at the things HHS can change, like the individual mandate. The individual mandate, which requires most people to have health insurance or face a tax penalty, has always been the most contentious part of the law.

At least, that’s how the mandate was interpreted during the Obama administration. In reality, the secretary of HHS can grant hardship exemptions to the mandate as she sees fit. Under the Obama administration, the hardship exemptions were granted to people who earned below 138 percent of the federal poverty limit and lived in states that didn’t expand Medicaid, or experienced a handful of other life circumstances, including homelessness or domestic violence.

But there’s nothing preventing the HHS secretary from granting hardship exemptions to everyone who doesn’t have insurance, rendering the mandate meaningless. If he’s confirmed, Rep. Tom Price, Trump’s pick to lead HHS, could have granted blanket hardship exemptions before the executive order was issued, but in case there was any question, the folks at HHS now have their bosses’ itemized list of priorities.

Granting broad exemptions without other changes could create chaos in the insurance marketplaces created by the ACA that mainly cover people without employer-sponsored coverage. Insurance companies rely on a mix of patients — healthy, sick, young, old — to balance out the money they gain through premiums and the money they dole out for health care. Without an individual mandate, younger, healthier people will very likely leave the marketplace, wreaking havoc within insurance plans and sending premiums rocketing up for those left behind. “This is a very sweeping order that could have huge ramifications for the ACA,” Larry Levitt, a senior vice president of the Kaiser Family Foundation, wrote in an email. “Potentially the biggest step implied by this order would be granting wide scale hardship exemptions from the individual mandate, which could create chaos in the individual insurance market.”

The Affordable Care Act also mandates that insurance plans cover a set of services without charging for them (beyond monthly insurance premiums), but it’s up to HHS to lay out the specifics. For example, that part of the ACA that requires contraceptives be provided to insured women free of co-pays or deductibles? That’s not written in the law; it was part of how the law was interpreted by the Obama administration. By one estimate, that interpretation saved women $1.4 billion in out-of-pocket spending from 2012 to 2015. Another estimate found savings of $483 million in a single year. The contraceptive mandate has been an object of ire and the subject of a Supreme Court case, and is likely to be one of the first things to go.

There are other important signals in the short executive order. It says HHS should “encourage the development of a free and open market in interstate commerce” and “provide greater flexibility to States,” suggesting that Trump will push HHS to grant more flexibility to states in how they implement the law.

It was no secret before Trump signed the executive order that he wanted the Affordable Care Act repealed, and all of these changes were possible before it was signed. But now Trump has made his intentions clear, with one of his first acts as president: The Department of Health and Human Services, “to the maximum extent permitted by law,” should get to dismantling.

Last edited by youngishbear on Mon, Jan 23 2017, 9:41 pm; edited 3 times in total