Trump Orders May Raise Rates, Result in More Uninsured

Policy changes will effect future markets but premium subsidies and patient protections safe going into open enrollment
Breast Cancer News
October 18, 2017
Eric Fitzsimmons, Copy Editor and Content Coordinator

REMEMBER: the Patient Protection and Affordable Care Act, also known as the ACA and Obamacare, is still the law. Open enrollment starts November 1 and runs through December 15. During that time you are able to go to your state’s health insurance marketplace at and sign up for an insurance plan if you need health insurance or want to change to a different plan. When you create an account, you will be told if you qualify to get subsidies to help pay your premiums every month. These subsidies are not affected by the recent executive orders and you can still qualify to receive them for 2018.

Though Congress may again try to change the healthcare law next year, any changes would likely take effect in 2019. Keeping health insurance without any gaps in coverage can protect you from the worst financial expenses of cancer treatment, so it is important to stay on an insurance plan even as national policies continue to be debated.


President Donald Trump made two announcements about national health policies on October 12, both of which may contribute to higher premium costs, insurance companies leaving the healthcare marketplaces and fewer people signing up for insurance plans.

Ending Cost-Sharing Reduction Payments

On October 12, the administration announced that it would stop funding what are called cost-sharing reduction payments. These payments are made monthly from the government to insurance companies that provide plans with fewer out-of-pocket costs to people with low incomes. Companies are required to offer these low-cost plans under the ACA.

The administration says Congress has the authority to fund those payments, not the administration. Congress must now vote to continue making those payments or risk further upsetting the marketplaces, raising prices and causing insurers to stop offering plans.

The effects of this month’s orders may not be seen in full for some time, but could be devastating. The Congressional Budget Office estimated earlier this year that stopping the cost sharing reduction payments would raise premiums 25 percent more than what is expected if the payments were carried out through 2020 and result in 1 million fewer people with coverage.

Many insurers already raised prices for 2018 in response to earlier threats Trump made about the cost sharing reduction payments. Many have already submitted their plans and prices for the coming open enrollment period but may still be able to withdraw plans or request changes before open enrollment starts in November.

The Executive Order

Earlier in the day, Trump signed an executive order that instructed federal government agencies to loosen rules regarding two types of health insurance: association plans and short-term plans. These plans provide a way around protections in the ACA that require insurers to accept everyone, regardless of health conditions, and cover basic health services.

Small businesses that operate in the same industry can join together in buying an insurance plan for their employees, called an association plan. This executive order asks agencies to change rules that limit who can get these plans and how they are treated under the ACA. Most insurance plans for small businesses have to go by ACA standards. This order could result in the government considering association plans to be in a different category that do not have to include the essential health benefits, 10 health services that plans under normal ACA rules are required to cover.

Short-term insurance plans are currently limited to three-month periods of coverage and are commonly used by people between jobs. This executive order may let short-term plans cover someone for up to a year. Though extending the length of coverage under short-term plans may help some people with gaps in employment, short-term plans do not count as health coverage under the ACA, so they do not have to accept people with pre-existing conditions and they do not have to cover the cost of essential health benefits. The ACA requires each person to have qualifying health insurance or pay a fine, and short-term plans do not count as qualifying insurance under the ACA. Still, people may be drawn to purchase short-term insurance if they believe they will have low health costs in the coming year and if the plans are cheap enough.

Making short-term plans and association plans available to more people may upset the balance that insurance plans need to stay affordable and cover participant expenses. If healthier people who don’t expect to need much health care this year choose these cheaper plans that cover few services, a greater percentage of people using the healthcare marketplace will be those who have expensive healthcare bills, because they need good coverage. To pay for their care, the premiums of marketplace plans will then have to rise. This means that in the marketplace, people who need more health care, like those with breast cancer or other serious conditions, will see much higher costs for their medical treatment. It also makes the marketplaces less stable, and could cause insurance companies to stop offering plans in parts of the country where there are already limited options.

Trump has long said that the ACA is failing and has pulled funding from programs meant to help people find and pay for health coverage. Efforts to repeal the law this year have not been able to pass Congress, but by making the market worse the Trump administration may hope to make those efforts more popular in 2018.

The timing of the announcements is causing confusion just when people are deciding whether to sign up for insurance. Your chance to enroll will be shorter and less publicized this year, the result of an earlier order from the administration. While some people will be able to find cheaper plans, these policies are expected to make affordable insurance harder to get for millions of people, especially those with pre-existing conditions and high medical bills.

The Lamar-Alexander Bill

On October 17, Sens. Lamar Alexander, a Republican from Tennessee, and Patty Murray, a Democrat from Washington, announced that they had agreed on a plan to continue funding the cost-sharing reduction payments. The senators have been working together for weeks to find a bipartisan approach to improve federal health laws. Their plan addresses some of the issues brought about by Trump’s announcements last week:

  • Cost-sharing reduction payments will be funded for the next 2 years.
  • Outreach efforts to let people know about open enrollment will be funded.
  • “Catastrophic” plans, which have low premiums but very high deductibles and out-of-pocket costs, will be made available to more people.
  • States will get more flexibility to install their own plans and waive parts of the ACA.

The Alexander-Murray plan is very early in the process. There is not a written bill yet and it is not clear if it will get enough support to pass Congress. Living Beyond Breast Cancer will continue to bring you updates on efforts to change the ACA.

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