Apr 28, 2019

Trump plans to formally give up on part of the Affordable Care Act

Photo: Mark Wilson/Getty Images

The Trump administration is about to formally give up on a part of the Affordable Care Act that had largely died on its own.

Driving the news: The Office of Personnel Management intends to stop administering the ACA’s multi-state insurance plans. Axios reviewed a draft of the notification letter OPM is planning to send to congressional leaders.

How it works: The ACA initially envisioned creating 2 multi-state plans — private insurance policies that would be available through the ACA’s insurance exchanges in every state. The goal was to provide guaranteed competition in states that lacked it.

  • But the policy never got off the ground. By 2017, there was just 1 plan operating in just 1 state: a Blue Cross Blue Shield plan in Arkansas.
  • OPM will tell Arkansas Blue Cross Blue Shield thanks for its cooperation, but then shutter the multi-state effort, according to the draft letter.

Between the lines: An administration official framed the death of the multi-state plans as a bad omen for "Medicare for All," arguing that it was “a pilot program for the public option, and it’s been a dismal failure with even the most liberal states balking on it.”

  • It’s true that this policy was designed to do some of the same things a public option would have done, and that it failed.
  • But it failed, in part, because its insurers never were very enthusiastic about setting up networks of doctors and hospitals across multiple states — which is also a bad omen for the conservative priority of selling insurance across state lines.

The bottom line: “I've always sort of felt like it was well-intentioned but not reflective of the right reality of what's limiting competition," Georgetown University health policy professor Sabrina Corlette told Axios back in 2017.

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