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Coffee CAHC policy round up: October 13, 2017

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!  Have suggestions or feedback? Let me know ( If you like these emails, please share them with others, and ask them to sign up here.


Coffee CAHC

115th Congress, 1st session

128th Maine Legislature, adjourned


Friday, October 13, 2017

While Steve is taking some much deserved vacation time, I am here with your Coffee CAHC update wondering if today being Friday the 13th of October, one the most superstitious and scariest days of the year is just a coincidence.

This week, we’re going to set aside our normal format for an all executive order edition of Coffee CAHC.


But first – Trump cuts cost sharing subsidies

But first, we need to address the bombshell the Trump administration dropped last night, with the decision to immediately stop paying cost sharing subsidies. This adds even more uncertainty to an insurance market that is already shaky.


Keep in mind that here in Maine, insurance companies already constructed their rates to account for the possible loss of cost sharing subsidies. Insurance companies are still required to provide lower out of pocket costs for people who qualify, even without these subsidies being paid by the federal government. This means that people who qualify for this help should still plan to enroll in subsidized silver plans.

All of this will create even more pressure on Congress to pass bipartisan marketplace stabilization that includes the payment of these subsidies. Experts say that if Congress acts, these subsidies could begin again immediately – you might call this a possible silver lining, if it spurs Congress to act..  But, as we’ve seen, Congressional action on the ACA is never easy. One thing is clear: this shows Trump’s commitment to damaging the ACA.  As Sam Baker of Axios wrote this morning:

No one benefits, in any practical way, from Trump’s decision. Consumers lose via higher premiums and fewer choices. Insurance companies lose money. Republicans lose time and energy for tax reform. There’s only one conceivable benefit here for Trump – screwing “Obamacare.”

Now, back to your regularly scheduled executive order edition of Coffee CAHC…


Executive Orders

What’s a president to do when he’s promised to repeal the Affordable Care Act, but Congress has failed to pass ACA repeal legislation?  Why, he takes out his pen and signs executive orders!

In the past week, President Trump has signed two executive orders: the first on the ACA’s birth control mandate (signed last Friday), and the second on association health plans (signed yesterday).  Let’s dive into the ins and outs of both orders, and what they mean for Maine people.

Birth control

Under the ACA, nearly all employers have been required to cover a wide variety of birth control options with no cost sharing.

The executive order Trump signed last Friday gives employers the option to take this coverage away, by opening up new opportunities to get exemptions from this requirement for religious or moral reasons.

Keep in mind that churches and other religious institutions have always been exempt from this requirement, as well as religiously affiliated hospitals and universities. After the Burwell v Hobby Lobby case, certain “closely held” businesses could also exclude birth control from employee coverage for religious reasons by requesting an exemption (although some groups still took issue with this process).

What this executive order does is allow any employer to request an exemption for any religious or moral reasons. These rules take effect immediately, although a comment period is open until December 5th (full text and details on commenting available (hereand here).

So, what will this mean for Maine people?  It’s hard to say for sure. No cost birth control is one of the most popular parts of the ACA, and experts believe it has contributed to the lowest ever rate of abortions in the US since Roe v Wade. The Trump administration said in this order that these new rules would impact very few women – but there is no reason that more companies couldn’t decide to drop this benefit in an effort to save money. That means that thousands of Maine women could lose the birth control benefits they have gotten at no cost under the ACA.

Health care – association health plans and short-term plans

Yesterday, President Trump signed an executive order directing member of his cabinet to do the following:

  • Expand access to association health plans;
  • Expand access to short-term health plans;
  • Expand the use of health reimbursement arrangements in employer sponsored coverage

What does this mean? In a nutshell, these changes would open up more opportunities for cheaper, skimpier health coverage by allowing small groups to band together to buy health insurance that sidesteps ACA consumer protections, and to broaden the use of short term insurance.

Unlike the order on birth control, this order does not have any immediate impact. Instead, Trump is directing the relevant agencies – treasury and health and human services – to consider rule changes that meet the goals outlines above. It’s hard to know the real impact these rules will have until we see the proposed rules.

So, what does this mean for open enrollment, or for the Marketplace? Since these rules don’t change anything right away, nothing has changed for the upcoming open enrollment period -although that doesn’t mean consumers won’t be confused about their options.

We will have to wait and see the impact on the Marketplace. Anything that opens up skimpier coverage options could mean that younger, healthier people leave the ACA Marketplace – – leaving sicker and older enrollees in the Marketplace with rising premiums. This could destabilize the Marketplaces, leading to higher premiums and fewer insurers.


Would you like to know more?


There’s a lot more to say about all of this, and what it could mean for Maine people. We will revisit these concepts in the coming weeks – if you have specific questions you’d like us to answer, please let us know by emailing!

Until then, here’s your reading list:

  • Health Affairs: 

Have a great weekend!


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