In addition to getting rid of the landmark Affordable Care Act, the Trump administration has made a historic and controversial change to Medicaid, allowing states to require many participants who got coverage through Obamacare to work or lose its benefits.
Another important focus of the president: the cost of medicines. Like the Democrats, Trump has repeatedly criticized the rise in the price of drugs, and his administration has presented multiple proposals to try to contain costs.
When it comes to Medicare, the administration has continued to make private Medicare plans more attractive. And according to conservative positions, officials have reversed access to contraceptives and abortion.
But after Congress controlled by Republicans could not repeal Obamacare, Trump unleashed a series of executive changes to promote undermine the law.
And Trump enacted the law of the Republican Party tax reduction bill that effectively eliminated the individual mandate by reducing the fine to $ 0, the basis of a federal court ruling that invalidates the entire Health Care Act under Price. That ruling is currently being appealed.
Trump also eliminated federal payments that help reduce deductibles and out-of-pocket costs for low-income participants, prompting insurers to increase premiums to cover the loss of these cost-sharing subsidies.
More recently, the Trump administration told the states that they could request exemptions to make more substantial changes to their Obamacare markets, including changing the rules on who is eligible to receive federal badistance to pay the monthly premiums. According to the experts, these subsidies to the premiums are essential to maintain the functioning of Obamacare.
Trump officials say their moves are aimed at providing greater access to more affordable health insurance options. They are particularly concerned about younger Americans and those who earn too much to qualify for federal subsidies. But Obamacare supporters say these actions will disrupt the strong protections for older consumers and those with pre-existing conditions.
The Trump administration plans to make even more changes to the Affordable Care Act for next year. Recently he launched a proposal that would increase the maximum amount that members have to pay out of pocket, a change that would also affect the plans of large employers. At the same time, it would make subsidies for federal premiums a little less generous, which, according to estimates, would reduce enrollment by 100,000 people.
But even more consequently, it is formally exploring the elimination of the annual automatic renewal of Obamacare plans. This would have a devastating impact as 1.8 million people in the 39 states that used the federal exchange were renewed this year.
Officials are also seeking information about the "silver charge," in which operators increased their rates for silver plans to compensate for the loss of cost-sharing subsidy payments. They did this to minimize the rate increases in the affiliates because the federal subsidies to the premiums are based on the second lowest cost silver plan.
So far, only Arkansas has implemented the new rules, which require beneficiaries to work, go to school, volunteer or look for work for at least 80 hours a month. The impact has been pronounced: more than 18,000 residents have lost coverage.
Prices of medicines
In the election campaign, Trump repeatedly promised to reduce the cost of medications. While it has issued many tweets that criticize the industry for raising prices and its administration has presented many proposals, has not moved the needle too much.
One of the most audacious and controversial efforts is to establish the level of Medicare reimbursement for certain expensive drugs administered in doctors' offices and outpatient centers of hospitals according to their cost in other countries, which is usually much lower. This idea provoked howls of "pricing" from the industry and conservative legislators.
The patient advocacy groups are concerned about another management effort that would give Medicare Advantage plans the ability to restrict what drugs they will cover. The Cancer Action Network of the American Cancer Society, backed by nearly 60 organizations, has just launched a print and digital advertising campaign to oppose policy changes.
Pharmaceutical companies are not paying attention to the President's call. According to an badysis conducted by Rx Savings Solutions, 60 drug manufacturers began 2019 by increasing the list prices of nearly 300 drugs. And more drug manufacturers are expected to follow suit silently in the coming weeks.
However, companies appear to be moderating their hikes in 2019. The average increase was 6.3%, compared to almost 9% a year ago, taking into account different doses of the same drug.
An official from the Department of Health and Human Services noted the lowest rate of increase in January.
One thing that the Trump administration has achieved is to approve a record number of generic drugs, which generally have lower prices. The White House Council of Economic Advisers estimates that this has saved consumers $ 26 billion during the first 18 months of the Trump administration.
State health insurance
Trump officials are also trying to control costs. For example, the Centers for Medicare and Medicaid Services is reviewing how it compensates physicians for office visits, reducing payment levels from five to three, beginning in 2021. But it also extends reimbursements for telehealth services.
Another goal: the Medicare Responsible Care Organization program, which has more than 10.4 million participants. Established by the Affordable Care Act, these organizations are groups of doctors, hospitals and other providers who work together to better coordinate patient care and reduce health care costs by avoiding duplication of services and errors doctors Known as ACO, they share the savings they get for Medicare, but only a few are hooked by the losses they generate.
Currently, ACOs in the Medicare Shared Savings Program have up to six years before they have to badume the costs if their per-patient spending exceeds their goals. Officials want to reduce that to just one year.
"His administration has not proposed directly reducing Medicare benefits or increasing beneficiary payments," said Mark McClellan, former administrator of the Centers for Medicare and Medicaid Services of former President George W. Bush and director of the Center for Health Policy. Health of Duke-Margolis. "Instead, their proposals seek to continue to grow the Medicare Advantage program and keep pushing for more payments based on value, not volume."
Access to birth control.
The administration is reducing regulations that conflict with the religious beliefs of some Americans. Last year, it issued two rules that would free more employers from Obamacare's contraceptive mandate.
The first would allow nonprofit and for-profit employers, including publicly traded companies, to receive an exemption based on their religious beliefs. The second would allow all companies, except public ones, to obtain an exemption based on moral objections. Government employers can not request exemptions.
The administration also proposed regulations that would no longer allow family planning services financed with federal funds in the same place where abortions are performed. And he has also proposed that Obamacare insurers separately bill abortion coverage and offer plans that do not cover abortion in states that do not require it.