April 3 2017

The spectacular collapse of the proposal to repeal and replace significant portions of the Affordable Care Act (ACA) was the result of the public outcry across the country, including in California. While many advocates for accessible, affordable, and quality health care spent several days rejoicing, attention is now shifting to the next threats to coverage and access on the horizon.

Even though Congress may be gridlocked on how to change the ACA, the federal administration can move forward with executive actions that could radically change the way the law is implemented, impacting the health of millions of people. Here are four of the most serious threats:

  1. At any moment, the administration could decide to end subsidies to insurers that help lower health coverage costs for low-income enrollees in the ACA, setting off a chain reaction that could quickly result in a major contraction of the individual market for Covered California and other states’ marketplaces.
  2. The U.S. Department of Health and Human Services (HHS) has already signaled its intent to give insurance companies greater flexibility that will enable them to reduce the benefits of the insurance plans they offer and shift more costs to consumers.
  3. In a recent letter to Governors, the Administration claimed that the expansion of Medicaid to non-disabled, working age adults without dependent children was a clear departure from the core, historical mission of the program of serving “the truly vulnerable.”  They articulated a series of “reforms” including:  alternative benefit plan designs and cost-sharing models; enforceable premium or contribution requirements; emergency room co-payments; or changes to enrollment or eligibility procedures that do not promote continuous coverage. While it is unlikely that California would go down this path, other states could use these mechanisms to limit access or eligibility, increase out-of-pocket expenses for people who qualify, or limit the scope of benefits that they currently provide.
  4. Earlier this year, the administration cut back on public awareness ads that were set to hit the airwaves in the final weeks of the ACA enrollment period, leading to 1.6 million fewer people enrolling than expected.  This came at a phase in the enrollment period when younger and healthier people tend to sign up for health insurance, without whom insurance rates for everyone else are more likely to rise. If the administration decides to conduct little or no public information campaigns about how to sign up during the next enrollment period, that will likely further narrow the pool of enrollees.

In addition to these executive actions, there’s nothing to prevent Congress from coming up with another bill to erode or repeal the ACA. In fact, members of Congress from both major political parties have begun talking about ways to amend the ACA, ranging from proposals to repeal the law outright, to making constructive changes to improve it.

For all these reasons, it continues to be important for those with the most at stake to stay vigilant and stay loud to move us closer to, rather than farther away from, health for all.