Photo: Brendan Smialowski/AFP/Getty Images

The Trump administration is using a regulatory workaround to achieve some of the same goals of Republicans' failed efforts to repeal and replace the Affordable Care Act.

Driving the news: HHS released new guidance yesterday about how it will approach the ACA's existing waiver process. It said it would, in some circumstances, approve waivers that go far beyond what's currently allowed.

  • States could change the way the ACA's subsidies are administered. They're currently based on income and the cost of insurance. States could change that to take consumers' age into account — a model that was also used in repeal-and-replace legislation.
  • States obtaining a waiver could also let people use their ACA subsidies to buy insurance that doesn't meet the ACA's coverage requirements — for example, newly expanded "short-term" plans that are able to turn away people with pre-existing conditions.

The big picture: This is one of the administration's most significant anti-ACA moves to date — if it works.

  • States that ask for everything they're now allowed to, and get it, could set up an insurance market that looks a lot different from what the ACA envisioned.
  • But they have to be approved first. Actuaries at the Centers for Medicare & Medicaid Services, who are independent from the agency's political leadership, will have to certify that a waiver wouldn't weaken the state's overall insurance market too badly.

What's next: The new standards and/or any approved waivers could face legal challenges — both on the merits and because these new rules were articulated in a guidance document rather than a formal regulation with opportunities for public comment, Brookings fellow Christen Linke Young writes.

Go deeper: Trump administration loosens rules for ACA waivers

Go deeper

Updated 17 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Politics: Senate Democrats block vote on McConnell's targeted COVID relief bill McConnell urges White House not to strike stimulus deal before election.
  2. Economy: Why the stimulus delay isn't a crisis (yet).
  3. Health: Studies show drop in COVID death rate — The next wave is gaining steam — The overwhelming aftershocks of the pandemic.
  4. Education: Schools haven't become hotspots — San Francisco public schools likely won't reopen before the end of the year.

Senate Democrats block vote on McConnell's targeted COVID relief bill

Photo: Stefani Reynolds/Getty Images

Senate Democrats on Wednesday blocked a vote on Republicans' $500 billion targeted COVID-19 relief bill, a far less comprehensive package than the $1.8 trillion+ deal currently being negotiated between the Trump administration and House Democrats.

Why it matters: There's little appetite in the Senate for a stimulus bill with a price tag as large as what President Trump and House Speaker Nancy Pelosi have been calling for. Senate Majority Leader Mitch McConnell's (R-Ky.) "skinny" proposal was mostly seen as a political maneuver, as it had little chance of making it out of the Senate.

The hazy line between politics and influence campaigns

Illustration: Aïda Amer/Axios

The recent firestorm over the New York Post’s publication of stories relying on data from a hard drive allegedly belonging to Hunter Biden shows the increasingly hazy line between domestic political “dirty tricks” and a foreign-sponsored disinformation operation.

Why it matters: This haziness could give determined actors cover to conduct influence operations aimed at undermining U.S. democracy through channels that just look like old-fashioned hard-nosed politics.