As always, he American Healthcare system is always changing. This is an update of some of the policy changes that have occurred in healthcare in the past month and what they mean for you. As we all may know, the Trump Administration has taken several steps to weaken the Affordable Care Act. The administration shortened the enrollment period by half and reduced funding for advertising the open enrollment period by 90%. At the conclusion of the 2018 open enrollment period, the Trump Administration reported that there was a decrease of roughly 400,000 people who signed up for healthcare this year.

Image of doctor holding an "open enrollment" sign.
Image of doctor holding an “open enrollment” sign. Image retrieved from http://bettertexasblog.org/2016/10/changes-open-enrollment-2017-youve-heard-means/

​The decrease in healthcare enrollees came from the 39 states that use the marketplace overseen by the federal government. In the 11 states that sell coverage for the Affordable Care Act, through their own marketplaces, enrollment numbers remained constant. While there have been decreases in the number of people who enrolled in health plans offered under the Affordable Care Act, insurance premiums have skyrocketed and many Americans are complaining about their lack of choice in healthcare plans. A report from the Centers for Medicare and Medicaid Services revealed that monthly premiums, before subsidies were applied, rose by 30 percent. This harsh reality has led the federal agency to propose an expansion of the availability of short-term insurance plans to provide additional options for Americans who cannot afford the drastic increases in health insurance premiums.

Image of hands reaching towards symbols of healthcare.
Image of hands reaching towards symbols of healthcare. Image retrieved from http://doloreslibrary.org/event/health-care-enrollment-info-session/

In some instances, state governments are challenging many of the changes the Trump Administration has made to the Affordable Care Act. Some states are working to develop their own version of the individual mandate to spread the cost of health insurance among those who are well and those who are ill. Other state governments are investing in outreach and marketing to promote the Affordable Care Act even though the federal government has drastically severed funding for these activities. The result will be a country further divided in the way people access health insurance and healthcare, which will all depend on where you live in. States not making these changes may have vastly different health insurance options that are limited in the health services covered; states trying to preserve the Affordable Care Act, however, may have more highly regulated plans with prices remaining a little higher.

Picture of a health plan form with eye glasses and prescription drugs.
Picture of a health plan form with eye glasses and prescription drugs. Image retrieved from https://www.healthedeals.com/articles/should-i-keep-my-grandfathered-health-plan-in-2016

​The White House has also made statements that it would support efforts to stabilize the Affordable Care Act, but only with the inclusion of measures valued by conservatives. One of these measures is the notion that all efforts need to be “life-protected”, which would ensure that funds from the federal government would not be able to be used for abortions. Outside of the short-term health plans, that were mentioned earlier, the Trump Administration has proposed expanding access to health savings accounts. The administration also suggested allowing insurers to charge the elderly population as much as five times more than younger people when the current ratio is three to one.

Image of people holding onto a crumbling "medicaid."
Image of people holding onto a crumbling “medicaid.” Image retrieved from http://money.cnn.com/2017/06/21/news/economy/medicaid-expansion-gop/index.html

Earlier this year, the Trump Administration proposed work requirements for Medicaid recipients. This requirement would mean that people would have to be employed, or volunteer, in some capacity to receive Medicaid, even though most recipients are minors or people with disabilities, who are exempt from this requirement. The work requirement is a part of a larger effort to hinder the expansion of Medicaid that has occurred in many state governments. The Trump Administration has begun to pilot the Medicaid work requirement by approving restrictive waivers for Kentucky, Indiana, and Arkansas. The waivers allow states, for the first time in the history of Medicaid, to take away coverage from people who are not working or engaging in work-related activities for a specified number of hours per month. In addition, the waivers do not offer any assistance searching for a job, job training, transportation, child care, or any other services to address issues that typically inhibit people from pursuing full-time jobs. As usual, American Healthcare remains in a state of chaos and confusion. There have been a few bills presented in the Senate to stabilize the Affordable Care Act, but we do not know what will happen next. Stay tuned for next month’s healthcare update.

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