Red and Blue States Move Further Apart on Health Policy
Democratic and Republican states are moving in opposite directions on health policy, leaving Americans with starkly divergent options for care depending on where they live.
The Trump administration and congressional Republicans, by easing many of the Affordable Care Act’s nationwide requirements after failing last year to repeal the entire law, are effectively turning major components of health policy over to the states. The roughly half of states controlled by Republicans are therefore moving aggressively to roll back the law widely known as Obamacare, while the smaller number of Democratic states are working to bolster it.
As a result, the health-care options in any given state are likely to depend on which party controls the statehouse. That dictates access, cost and coverage, particularly for the roughly 17 million people nationwide who buy their own insurance and the 29 million people who lack it entirely.
Increasingly, state health-care policy reflects the ruling party’s goals. In Democrat-controlled California, a patient with a costly medical condition may likely get relatively affordable premiums, while a young, healthy and self-employed professional could pay more. In Republican Texas, the sicker patient will likely do less well or go without coverage, while the younger, healthier one will have less-comprehensive options that may cost far less.
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This divergence reflects a seismic rollback of the Obama administration effort to promote a more standardized, nationwide health system. The ACA sought to have the healthy help cover the costs of the sick and the wealthy help cover the poor, and it has led to about 20 million people gaining health coverage. But Republicans have long balked at the ACA’s idea of taxing higher earners to pay for health care and have opposed the law’s mandate that individuals who don’t get care through their job or through a government program get coverage or pay a penalty.
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After congressional Republicans tried repeatedly last year, unsuccessfully, to repeal the health law, they did repeal the individual mandate, beginning in 2019.
In the meantime, the Trump administration has worked to take apart the law piecemeal. One proposal would allow the type of less-comprehensive health plans limited under the ACA. Another would let businesses and some individual band together in associations to get non-ACA-compliant plans. Those actions, along with a willingness to impose new requirements on Medicaid, have emboldened Republican-led states to further undercut the law they have long opposed and raised alarm in Democratic states, where lawmakers are preemptively looking to buttress the law from any GOP policy changes.
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Under the administration’s proposals, states are expected to get more flexibility in waiving some ACA requirements and oversight of plans that don’t comply with the ACA.
Democrats say non-ACA-compliant plans would siphon younger and healthier people away from the law’s exchanges, which they say would cause premiums for older and less-healthy people to jump. Republicans say being able to offer cheaper and less-comprehensive plans amounts to more consumer choice.
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Democrat-led states such as California and Maryland are looking to block or limit the expansion of cheaper and less-robust health plans that don’t adhere to ACA rules. Nearly a dozen states are considering measures requiring residents to have health coverage, essentially re-imposing an individual mandate with new modifications.
Washington state Insurance Commissioner Mike Kreidler said he is drafting a rule that would ban so-called short-term plans, which aren’t ACA-compliant, from being carried longer than 90 days.
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https://www.wsj.com/articles/red-and-blue-states-move-further-apart-on-health-policy-1519813801
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We have to take back the House!
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