How the Trump administration planned to change the ACA

A never-before-released document shows the extent of plans within HHS and the Trump administration to alter the Affordable Care Act (ACA) through executive and regulatory action, many of which have since been enacted.

The document was shared with members of the House Freedom Caucus on March 23, 2017, as HHS Secretary Tom Price, MD, tried to win their support on the American Health Care Act (AHCA), one of many attempts by congressional Republicans to repeal and replace the ACA last year.

Sen. Bob Casey, D-Pennyslvania, obtained the document after blocking three nominees to positions within HHS. He then shared it with POLITICO, calling it a list of options for “sabotage” of the ACA:

“The primary problem here is government officials, government agencies, were taking steps that would lead to fewer people having coverage and erecting barriers to people having coverage,” he said. “In addition to that, you have kind of a closed-door, back-room slimy deal here that should trouble anyone.”

The list of potential administrative actions regarding the ACA promised to “improve the individual and small group markets most harmed by Obamacare.” Several of those have since been implemented, such as stricter verification for special enrollment periods, shortening the open enrollment period to six weeks and letting state regulators make decisions on benchmarks for required health benefits and network adequacy for exchange plans.

Others have not been implemented, such as encouraging states to build “skinny exchanges” which would purportedly “cost less and rely more on private sector innovation.”

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