Next: Pres­i­dent Don­ald Trump still con­trols the fate of Oba­macare.

Ad­min­is­tra­tion can shore up ACA or let it at­ro­phy

The Denver Post - - FRONT PAGE - By Amy Gold­stein and Juliet Eilperin

WASH­ING­TON» Al­though House Speaker Paul Ryan, R-Wis., ac­knowl­edged Fri­day that “Oba­macare is the law of the land,” its sur­vival or col­lapse in prac­ti­cal terms now rests with de­ci­sions that are in Pres­i­dent Don­ald Trump’s hands.

In the com­ing weeks and months, the White House and a highly con­ser­va­tive Health and Hu­man Ser­vices sec­re­tary will be faced with a se­ries of choices over whether to shore up in­sur­ance mar­ket places cre­ated un­der the Af­ford­able Care Act — or let them at­ro­phy. These mar­ket­places are a con­duit to health cov­er­age for 10 mil­lion Amer­i­cans, but they have been fi­nan­cially frag­ile, prompt­ing spik­ing rates and de­fec­tions of ma­jor in­sur­ers.

In the seven years since a Demo­cratic Congress passed the law, pub­lic sen­ti­ment over it has been closely di­vided. Sup­port has grown slightly in re­cent months.

There are many levers within the ACA that the Trump ad­min­is­tra­tion could use to un­der­mine the law or, in­stead, try to sta­bi­lize its mar­ket­places. In ad­di­tion, fed­eral rules could be re­de­fined, giv­ing the gov­ern­ment’s health poli­cies a more con­ser­va­tive twist even with the law still in ef­fect.

Ac­cord­ing to health care ex­perts from across the ide­o­log­i­cal spec­trum, an im­mi­nent ques­tion is whether the po­lit­i­cal tu­mult sur­round­ing the ACA’s fate and the pres­i­dent’s talk of ex­plo­sion could fur­ther shake the con­fi­dence of con­sumers and in­sur­ers alike. Do­ing so could prompt ex­its from the mar­ket­places.

The de­ci­sions fac­ing the ad­min­is­tra­tion are, in essence, a se­quel to an ex­ec­u­tive or­der the pres­i­dent is­sued his first night in of­fice, when he di­rected fed­eral agen­cies to ease the reg­u­la­tory bur­den that the ACA has placed on con­sumers, the health care in­dus­try and health care providers. So far, the main ac­tion stem­ming from that di­rec­tive is a move by the In­ter­nal Rev­enue Ser­vice to process Amer­i­cans’ tax re­funds even if they fail to sub­mit proof that they are in­sured, as the ACA re­quires.

But there are other steps the ad­min­is­tra­tion could take. A ma­jor one would be to end cost-shar­ing sub­si­dies the law pro­vides to lower- and mid­dle-in­come peo­ple with mar­ket­place plans to help pay their de­ductibles and co-pays.

Speaker of the House Paul Ryan holds a news con­fer­ence in the House Vis­i­tors Cen­ter af­ter a Repub­li­can cau­cus in the U.S. Capi­tol on Fri­day in Wash­ing­ton. Ryan can­celed a vote for the Amer­i­can Health Care Act. Drew Angerer, Getty Im­ages

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