Feds say states can al­ter health sub­si­dies

Belleville News-Democrat - - Nation & World - BY AMY GOLDSTEIN

The Trump ad­min­is­tra­tion is urg­ing states to tear down pil­lars of the Af­ford­able Care Act, de­mol­ish­ing a ba­sic rule that fed­eral in­sur­ance sub­si­dies can be used only for peo­ple buy­ing health plans in mar­ket­places cre­ated un­der the law.

Ac­cord­ing to ad­vice is­sued Thurs­day by fed­eral health of­fi­cials, states would be free to re­de­fine the use of those sub­si­dies, which have since 2014 pro­vided the first help the gov­ern­ment ever has of­fered con­sumers to af­ford monthly in­sur­ance pre­mi­ums.

States could al­low the sub­si­dies to be used for health plans the ad­min­is­tra­tion has been pro­mot­ing out­side the ACA mar­ket­places that are less ex­pen­sive be­cause they pro­vide skimpier ben­e­fits and fewer con­sumer pro­tec­tions. Even more dra­mat­i­cally, states could let res­i­dents with em­ployer­based cov­er­age set up ac­counts in which they min­gle the fed­eral sub­si­dies with health-care funds from their job or per­sonal tax-de­ferred sav­ings funds to use for pre­mi­ums or other med­i­cal ex­penses.

If some states take up the ad­min­is­tra­tion’s of­fer, it would un­der­mine the ACA’s cen­tral changes to the na­tion’s in­sur­ance sys­tem, in­clud­ing the es­tab­lish­ment of na­tion­wide stan­dards for many kinds of health cov­er­age sold in the United States.

An­other goal of the ACA, the sprawl­ing 2010 law that was Pres­i­dent Barack Obama’s pre­em­i­nent do­mes­tic ac­com­plish­ment, was to con­cen­trate help on the so-called in­di­vid­ual in­sur­ance mar­ket that serves peo­ple who do not have ac­cess to af­ford­able health ben­e­fits through a job.

Prices were of­ten out of con­trol and dis­crim­i­na­tion against un­healthy peo­ple was more preva­lent be­fore the ACA im­posed re­quired ben­e­fits, pro­hib­ited in­sur­ers from charg­ing more to peo­ple with pre-ex­ist­ing con­di­tions and cre­ated a fed­eral health ex­change and sim­i­lar state-run mar­ket­place in which pri­vate in­sur­ance com­pa­nies com­pete for cus­tomers.

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