Oct 23, 2018

Why the new ACA waivers matter

As in-the-weeds as a revised waiver process sounds, the practical effects of what the Trump administration announced yesterday could add up to one of its most substantive blows yet against the Affordable Care Act.

The big picture: These changes will likely cause more separation of healthy and sick people, but only in states that avail themselves of these new options — creating another level of segmentation between red and blue states.

How it works: Under the Obama administration, states seeking a waiver from the ACA’s rules had to show that their alternatives would cover just as many people as the ACA, with insurance that’s just as robust, for the same cost. That’s why only 8 waivers have ever been granted.

  • But under the Trump administration’s approach, if the same number of people have access to ACA-level coverage, that’ll count — even if few of them actually choose it.
  • Likewise, “a waiver that makes coverage much more affordable for some people and only slightly more costly for a larger number of people would likely meet” the new standards, the formal policy guidance says.
  • States could, for example, seek a waiver that would let their residents apply the ACA’s premium subsidies to “short-term” insurance plans, even though those plans don’t meet the ACA’s requirements, including the mandate to cover people with pre-existing conditions.

Between the lines: The Trump administration has often treated the ACA’s exchanges as a de facto high-risk pool. And that’s the best prism through which to understand these latest changes.

  • These waivers will let states lean even further into new, non-ACA options for healthy people. That will likely increase premiums for ACA coverage. But because the vast majority of ACA enrollees are subsidized, they’ll be insulated from those costs.

There are limits to how far that dynamic can go, because states' waivers still can’t add too much to the federal government’s costs. But that’s the basic dynamic at play here — and it’s one that will continue to move the larger individual market further and further away from the ACA.

Go deeper

Stocks fall 4% as sell-off worsens

A trader on the floor of the New York Stock Exchange. Photo: Johannes Eisele/AFP via Getty Images

Stocks fell more than 4% on Thursday, extending the market’s worst week since the financial crisis in 2008 following a spike in coronavirus cases around the world.

The big picture: All three indices closed in correction territory on Thursday, down over 10% from their recent record-highs amid a global market rout.

Coronavirus updates: California monitors 8,400 potential cases

Data: The Center for Systems Science and Engineering at Johns Hopkins, the CDC, and China's Health Ministry. Note: China numbers are for the mainland only and U.S. numbers include repatriated citizens.

33 people in California have tested positive for the coronavirus, and health officials are monitoring 8,400 people who have recently returned from "points of concern," Gov. Gavin Newsom said Thursday.

The big picture: COVID-19 has killed more than 2,800 people and infected over 82,000 others in some 50 countries and territories. The novel coronavirus is now affecting every continent but Antarctica, and the WHO said Wednesday the number of new cases reported outside China has exceeded those inside the country for the first time.

Go deeperArrowUpdated 1 hour ago - Health

Watchdog opens probe into VA secretary over handling of sexual assault claim

VA Secretary Robert Wilkie on Fox Business Network’s "The Evening Edit" on Jan. 7. Photo: Steven Ferdman/Getty Images

The Department of Veterans Affairs Inspector General Michael Missal said Thursday he had opened an investigation into VA Secretary Robert Wilkie after lawmakers demanded an inquiry into his handling of a sexual misconduct report, the Washington Post reports.

Context: Wilkie allegedly "worked to discredit" the credibility of Democratic aide and veteran Andrea Goldstein after she reported last fall "that a man groped and propositioned her in the main lobby of the agency's D.C. Medical Center," a senior VA official told the Post.