Leaked Memo Details Trump Administration’s ACA Plans
A Trump Administration memo detailing plans to dismantle provisions of the Affordable Care Act (ACA) through executive action was made public last week. Released by Senate Democrats, the one-page document lists ten possible points of action to follow up on the President’s 2017 Executive Order to reduce the “economic burden” of the ACA. A number of the initiatives have already been enacted, while others, including weakening the essential health benefits requirement, are currently being considered.
The action plan included the following policies:
- Tightened special enrollment periods (require verification of eligibility);
- Restrict grace periods for paying premiums;
- Shorten open enrollment periods for ACA exchanges;
- Return network adequacy authority of it to states;
- Allow states more flexibility in defining essential health benefits (EHBs). This proposal is particularly harmful to the behavioral community as states could use this new authority to weaken the essential health benefits, a requirement that ensures health plans include coverage for mental health and substance use services;
- Expedite Section 1332 waivers;
- Disallow third party payment of premiums (steering patients to private coverage instead public coverage to be discouraged);
- Give states more flexibility in permitting lower cost direct enrollment pathways for insurers, brokers, and states;
- Give states more benefit design flexibility; and
- Encourage states to build “skinny exchanges”.
The document was originally presented to select House conservatives at a March 2017 meeting — which took place shortly before the first House vote on a bill to repeal the ACA. The meeting included House Speaker Paul Ryan (R-WI), Budget Director Mick Mulvaney, former Health & Human Services (HHS) Secretary Tom Price, as well as top Trump officials and a member of the House Freedom Caucus.