For months, President Trump has been frustrated at the Congressional Republicans' inability to repeal and replace the Affordable Care Act. After all, one of his biggest campaign promises was to get rid of President Obama's signature healthcare law, and it's something the Republican party has promised for the past seven years. Despite several attempts to repeal, Republicans have not been able to move the needle, so Trump is now taking the matter into his own hands with a series of unilateral decisions — including executive actions and new federal rules introduced last week.
Granted, the healthcare system is very complicated (Trump has said so himself) and understanding the president's decisions to change things up can be very confusing. To help you navigate the most recent healthcare news, we broke down what Trump is actually doing to dismantle Obamacare, and how could it impact your life.
The Decision To Stop Paying Subsidies
What are the Obamacare subsidies: Cost-sharing reduction subsidies, better known as CSRs, allow reduced healthcare costs for low-income Americans. The subsidies are in essence a form of compensation the federal government gave insurers if they lowered the out-of-pocket costs their low-income customers have to pay.
How it worked before: Obamacare targeted people who don't qualify for Medicaid but are still low-income to receive CSRs for their private insurance. The federal government pays insurers to lower deductible and copayments. The less money these low-income people make, the more help the federal government offers them. According to the Kaiser Foundation, the Obamacare subsidies lowered out-of-pocket costs by about $1,000 per person.
What Trump said: For months, Trump threatened to nix the subsidies. On Thursday night, the White House announced it would stop making those payments.
How could it impact you: Premiums have already gone up because of the uncertainty created by Trump's threats. Most rates for 2018 have already been set, so there won't be any big changes right away. However, the administration's decision to end the subsidies could lead to turmoil in the marketplaces in the long term and further increase prices.
The Executive Order On Association Health Plans
What are association health plans: Small businesses can join together to buy insurance and ultimately offer cheaper premiums.
How it worked before: Pre-Obamacare, national associations could choose which state's insurance market rules they wanted to follow, and then apply those guidelines for the plans they offered nationwide.
But Obamacare's regulations changed that: Association health plans started being treated like small businesses. The ACA also forced associations to follow all mandates in the healthcare law, including offering essential health benefits such as maternity care, hospital care, and prescription drug coverage. These protections barred insurers from offering skimpy coverage that would attract the young and healthy at the expense of the elderly and the sick.
What Trump said: The executive order instructs agencies to rewrite those Obamacare regulations. Under this order, association health plans can be expanded and be classified as "large employers," which are subjected to different rules under Obamacare.
How could it impact you: Depending on what new regulations the federal agencies come up with, association health plans would be able to offer skimpier health plans for cheaper, which could be attractive to businesses employing younger and healthier people. And because these plans are likely to attract those groups, the remaining small businesses in the Obamacare's marketplace would probably keep consumers who are older and sicker — something that insurers are unlikely to find attractive, because it costs more.
Experts believe the changes to the regulations won't be finalized any time soon, so consumers should not expect to see changes until at least 2019.
The Roll Back Of The Birth Control Mandate
What is the birth control mandate: The Affordable Care Act required all health insurance plans to cover birth control — including the pill, IUDs, and more — without out-of-pocket costs.
How it worked before: Before Obamacare, it was up to employers to determine whether they covered contraception. In the early 2000s, some women sued their employers, arguing they were facing sex discrimination if the employer covered preventive medicine for men but didn't cover birth control for women.
Because of this flurry of lawsuits, 28 states passed laws requiring insurance plans to cover preventive medicine, including birth control. With the Affordable Care Act, President Obama turned that state-based trend into a federal rule. The contraception mandate included an exception for churches, certain for-profit organizations, and some charities who could raise religious or moral-based objections to covering contraception.
What Trump said: With Trump's blessing, the Health and Human Services Department issued a new rule providing employers more flexibility to say they had moral or religious objections to providing birth control coverage.
How could it impact you: The Obamacare birth control mandate gave more than 55 million women in the U.S. access contraceptives without out-of-pocket costs. If you're an employee in one of the places that decide to opt out of covering contraception thanks to the new Trump rule, what you pay for your birth control may increase exponentially.