On Wednesday, the Trump administration released a final rule that will expand the availability of short-term health plans by allowing people to enroll in this substandard coverage for up to 12 months, rather than the current three-month limit. Short-term plans do not need to comply with the Affordable Care Act’s (ACA) consumer protections, meaning they can deny people coverage based on their medical history, create skimpy benefits packages, and charge people higher premiums because of pre-existing medical conditions. While consumers will still have access to the comprehensive coverage offered by ACA marketplace plans, this expansion of access to short-term plans will create a parallel market that will siphon off healthier consumers and lead to increasing premiums for those living with pre-existing conditions who rely on the ACA’s comprehensive coverage.

Yet another piece in the sabotage puzzle

This latest rule is just one in a slew of attacks the Trump administration has made on the consumer protections and coverage gains made under the ACA. After repeatedly failing to repeal the ACA in a Republican-controlled Congress, the administration – for political gain – has now taken to the strategy of slowly gnawing away at the law, threatening access to health care for millions of Americans. It becomes the next piece in an ever-expanding puzzle of sabotage:

  • Creating roadblocks to access comprehensive coverage: Just a few weeks earlier, the Trump administration advanced its agenda by cutting navigator funding by nearly 90 percent from 2016 funding levels. The navigator program provides crucial funding for unbiased, in-person assistance to help individuals and families enroll in health insurance, and these cuts will likely result in many regions throughout the country having no in-person enrollment assistance this year. In a vein similar to enrollment sabotage, the Trump administration is also making it harder for people to enroll in or keep their health insurance in the Medicaid program. In January, the Centers for Medicare and Medicaid Services (CMS) announced that it would reverse decades of precedent and permit states to mandate work or work-related activities as a condition of Medicaid coverage, which could result in as many as four million people losing Medicaid coverage.
  • Chipping away at pre-existing condition protections: In a final rule mirroring the intent of the short-term plan rule, the Administration moved to roll back consumer protections and encourage subpar insurance policies by loosening rules surrounding association health plans. And in taking yet another bite out of the ACA’s marketplaces, the Trump administration is now encouraging navigators who receive the administration’s paltry enrollment funding to steer consumers towards these newly available junk insurance plans, threatening the affordability of comprehensive health coverage. The Trump administration has also refused to uphold its legal and constitutional responsibilities to defend the ACA in a federal lawsuit that threatens to strike down the law, including its protections for people with pre-existing conditions.
  • Threatening women’s access to health care: The administration has also pursued discriminatory policies that would threaten women’s access to health care by issuing rules that would create loopholes for employers to deny coverage for contraception, eliminate Title X funding for clinics that provide critical reproductive health care services, and allow health care providers to deny medical care because of their religious, moral or personal beliefs. And in a move that could threaten access to reproductive health care for decades to come, the President is working to fill Justice Kennedy’s seat on the Supreme Court with an anti-choice nominee.

Putting the pieces together

These actions by the Trump administration are not just political bluster, but rather substantive policy actions with very real repercussions. While the ACA’s marketplaces have been shown to be resilient in the face of sabotage, these policies could drive up premiums and result in millions of people losing health coverage in 2019. These actions are also creating an environment of intense uncertainty for those who rely on the ACA’s consumer protections, especially for the 133 million adults under the age of 65 who have a pre-existing condition.

In the wake of these unprecedented attacks on people’s health care, polling demonstrates that health care is top of mind for voters, especially as the midterm elections approach. Nearly two-thirds of voters have listed a candidate’s support for pre-existing conditions as a very important factor in their vote, and a majority of voters support Congressional candidates who oppose repealing the ACA. As we approach the midterm elections, it will be critical that policymakers listen to their constituents and are held accountable for their actions as they continue to threaten people’s access to health care.