The Trump Administration has been making small changes to the Affordable Care Act through CMS and HHS that deregulate healthcare.

One example of this is the new set of rules issued by CMS in 2019; see: CMS issues final 2019 Payment Notice Rule to increase access to affordable health plans for Americans suffering from high Obamacare premiums.

This official CMS document includes language like:

Today, the Centers for Medicare & Medicaid Services (CMS) issued the HHS Notice of Benefit and Payment Parameters for 2019. The final rule will mitigate the harmful impacts of Obamacare and empower states to regulate their insurance market. The rule will do this by advancing the Administration’s goals to increase state flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce unnecessary regulatory burdens imposed by the Patient Protection and Affordable Care Act.

“Too many Americans are facing skyrocketing premiums that they can’t afford and every year consumers are faced with the threat of fewer choices. This rule gives states new tools to stabilize their health insurance markets and empower citizens to find coverage that fits their families’ needs and budgets,” said CMS Administrator Seema Verma.

As you can see, CMS is taking a strong stand against the harmful impacts of the program they are partly in charge of implementing and maintaining, the Affordable Care Act. This stand involves minor rules changes that decrease the regulator burden on individuals, businesses, insurers, and states.

The deregulation takes some key elements of the ACA like essential health benefits and qualified health plans, and allows states and insurers to offer less (with the idea being this will reduce costs). It creates additional exemptions for the mandate for tax payers with one or less insurer. It includes stronger checks on income for cost assistance. It lets insurers raise rates to 15% before it triggers a rate review (instead of 10%). It makes some changes to special enrollment. And, it lets small businesses get tax credits even if they enroll outside of the marketplace.

Insight into opinions: Nothing here is that big on its own, but together the many rule changes like this done under CMS and HHS, along with the executive orders that affect the ACA, add up. This may together all work as the reform needed in healthcare (perhaps deregulation will fix our healthcare system and make coverage affordable?) However, the fear would be that the long list of slight deregulations and changes to the ACA will actually decrease the effectiveness of the program and not solve our healthcare problems. Fundamentally, the problem with this is that we still have millions of uninsured and millions who struggle with costs, and thus a solution that doesn’t solve the problem isn’t much help. Politically and in terms of future reform, the problem with this is that if the ACA stops working or gets less effective due to all these small under the radar rule changes, people might think it was the Affordable Care Act and not the countless changes from the rejection of Medicaid expansion all the way to this recent set of rule changes that was the root of the problem. When people are upset that they can’t get coverage despite being low-income in a state that rejected Medicaid expansion, they tend to blame the ACA (or at least this is what I’ve seen on this blog over the years). However, it was a conservative lawsuit and conservative leadership who rejected medicaid Expansion, not “ObamaCare” (ObamaCare is what states can use to expand Medicaid). The complexity of healthcare presents a number of challenges across the board, both political and in terms of effective policy. Hopefully these rule changes will prove to improve the exiting system, and not just unnecessarily trim it around the edges. We can’t forget that not every useful thing is a thing we like. The mandates and essential health benefits, like pre-existing conditions protections, raise costs… but they also are the glue that hold together the current system. So removing them bit by bit is a potentially slippery slope if we don’t want to see everything come unglued.

What do you think?

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