Five Threats to Medicaid and the ACA Not Making Headlines

Dan Rabbitt — Project Manager, Health Policy

Rumors continue to swirl about a fresh vote to repeal and replace the ACA, but other more subtle actions might be just as dangerous at this point. Successful interference in the functioning of the ACA or Medicaid would not only harm the system and those who depend on it, but might also change the political dynamic enough that members of Congress feel they have cover to push through a full repeal and replace.

We must stay vigilant and prevent any efforts, whether overt or indirect, to undermine the ACA.

Here are five threats to Medicaid and the ACA that you haven’t seen in the headlines:

  • Discontinuing Cost Sharing Reduction Payments: The ACA provides subsidies called Cost Sharing Reductions (CSRs) to help people with lower incomes pay for out-of-pocket costs like deductibles. The Administration indicated this week that they will continue to fund the CSRs, but only after several weeks of threatening to end them. Pending litigation puts CSRs on tenuous ground — making it essential that the Administration not only continue these payments now, but show willingness to fight for them in court.
  • Poor Private Insurer Participation in the Marketplace: The ACA depends in part on participation by private health insurers, but last year several large insurers announced that they were dropping out, reducing enrollee choice and leading some to question the ACA’s viability. This is a solvable problem, but it will take action from the federal government. High profile exits or large premium increases could destabilize the market and renew calls for dramatic changes to the ACA.
  • Administrative Policy Changes: The Administration can unilaterally make changes to the ACA through regulatory action. For instance, the open enrollment period was recently reduced from 90 days to 45 days, making it harder for consumers to enroll and take the time to make adjustments to their coverage. Other changes, like weakening the required benefits that plans must provide, are rumored to be on the way.
  • Policy Riders: In Congress, controversial changes are often added to pieces of legislation that need to pass, like government funding bills. These amendments are called ‘riders’ and they can do serious damage. In fact, the premium increases seen in 2016 were due in part to a policy rider that cut funding to insurers. While technical, we must keep our eyes open for attempts to undermine the ACA through this backdoor.
  • Children’s Health Insurance Program Reauthorization: The biggest “must pass” health care legislation on deck in 2017 is the reauthorization of the Children’s Health Insurance Program (CHIP). CHIP, also known as AllKids in Illinois, provides health coverage for children whose families may not be able to afford private insurance, but who earn too much for traditional Medicaid. Opponents of Medicaid could use this reauthorization as a bargaining chip to force harmful changes to Medicaid or other pieces of the ACA.

Without vigilant attention and continued action, these types of changes could slip through unnoticed, whittling away at our health care system and setting the stage for further large-scale action. All concerned Illinoisans need to speak out if we are to succeed in defending these critical programs. Please sign up for the Protect Our Care — Illinois coalition to get involved in the work to save our health care and keep in touch with the Heartland Alliance policy team to stay up to date.