Facing a years-long wait before they can fully implement a planned repeal of the Affordable Care Act, Republicans lawmakers are exploring how the Trump administration can quickly trim required health insurance benefits under the law and lower the cost of health plans, said key GOP congressional aides.
Republicans plan to use a fast-track procedure to repeal the Affordable Care Act, but with a built-in delay to postpone full repeal for years while they navigate the complexities of passing a replacement. By going after the benefit rules now, however, they can take advantage of the broad authority given to the executive branch when the law passed to make faster changes, said the aides, who spoke on condition of anonymity because the process is ongoing.
Known as “essential health benefits,” the benefit requirements being examined are 10 broad categories of services all ACA plans must cover, such as preventive and wellness care, mental-health services and prescription drugs. Other options the administration could take quickly include narrowing the times and circumstances when people can sign up for coverage under the law, or letting states get more waivers from requirements under the law, according to the Republican aides.
The proposals are just one option being considered by Republicans as President-elect Donald Trump’s administration plans a wide roll-back of rules implemented by the Obama White House. Such efforts, which Trump’s administration could do unilaterally, are attractive because they avoid lengthy fights with Congress and fit with the president-elect’s theme of fewer government rules.
Tom Price, Trump’s pick to head health-care efforts, has already mapped out his priorities for undoing the benefits rules. Price, who has been tapped to be Secretary of Health and Human Services, has every year since 2009 introduced legislation that eliminates the essential health benefits and other requirements under the law.
Representatives for the Trump transition didn’t respond to requests for comment. Price’s office declined to comment.
Republicans have favored giving consumers the option to buy low-cost, catastrophic insurance policies with limited benefits —and limiting the benefit requirements would be a step toward more of those sorts of plans.
Republicans in Congress are grappling with their campaign promises to immediately repeal Obamacare, and what could be a lengthy and difficult process of replacing it with their own policy. Regulatory changes would give the administration something to show immediately, though would likely not go into full effect until 2018 or after.
Rules at risk
Many of the law’s rules were given to regulators to implement, said Mike Leavitt, former HHS secretary under President George W. Bush, which also means they can be undone. “I think they’ll send more to the states,” Leavitt said. “They’ll say, ‘I think consumers are able to make a lot of these decisions.’” He’s consulting with the Trump team on technical matters in the White House transition.
The political feasibility of cutting some benefits, such as mental-health coverage is less certain, say supporters of the law. Nor is it certain how much eliminating others, like birth control, would actually do to lower premiums that have been rising under the law.
“Are they going to take out mental health?” said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who is widely considered a key architect of Obamacare. “Are they going to take out prescription drugs? They talk as if there’s all this fluff they can take out and suddenly reduce costs a lot. There’s not.”
The most vulnerable benefit to face the chopping block is contraception coverage, said Timothy Jost, an emeritus professor of law at Washington and Lee University, another backer of the law.
“Contraceptives cost money and they also save money,” Jost said. “It would probably cost more to get rid of the requirement than it would save.”
Representative Mark Meadows, the incoming chairman of the conservative House Freedom Caucus, last week sent a memo recommending Trump cancel more than 200 federal regulations, including Obamacare preventive services rules and the mandate for most employers to provide contraception coverage. Jost called such targets “ideological.”
The essential benefits package rules apply only to health plans sold through the marketplaces known as exchanges. They’re also separate from the part of the Obamacare law that requires health insurers provide some services, including contraception, at no cost to the patient.
Douglas Elmendorf, former Congressional Budget Office director from 2009 to 2015 who is now dean of the John F. Kennedy School of Government at Harvard University, said that cutting up-front benefits won’t save consumers money in the long-term.
“We shouldn’t pretend that it just goes away,” Elmendorf said. “You’re paying for it out of pocket instead of a premium.”
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