Chipping Away at the Affordable Care Act: Payments to Insurers Suspended

One of the campaign promises Donald Trump appears to care about living up to is undermining all things Obama, not the least of which is the Affordable Care Act (ACA). The Trump administration’s latest bit of chipping away at the Affordable Care Act has been to suspend billions of dollars of “risk adjustment” payments to insurers who offer plans through the health exchanges set up as a result of the Affordable Care Act.

“Risk adjustment” payments pool risk for insurance companies, stabilize markets, and eliminate the incentive for insurers to restrict coverage only to healthier individuals and those without pre-existing conditions. The Affordable Care Act prohibits insurers from rejecting either type of potential member. Risk adjustment funds use money collected from insurers with healthier participants (and lower costs) to help supplement costs for insurers who take on the higher costs of enrolling sicker members.

The Trump administration cites a New Mexico district court ruling that disputes the current government formula for calculating the payments, and calls for their temporary suspension. A Massachusetts district court, however, upheld the current formula. Though the two rulings are in direct opposition to each other, the Trump administration has decided that it must abide by the New Mexico ruling – the one that would be most likely to lead to one more unraveling of the Affordable Care Act.

This is another step in making the marketplace “as inhospitable as possible,” according to Rodney Whitlock, Vice President of Health Policy at ML Strategies.

“The executive order the president signed, not long after he got to the White House after the [Inaugural] Parade was effectively, ‘We’re declaring war on the Affordable Care Act,'” says Whitlock.

Each year, fewer insurers participate in the health exchanges. Without the $10.4 billion in adjustment payments, or even with a delay in the payments, it’s likely that next year will see even fewer participating insurers and plans. Those who do participate are likely to significantly increase premiums for 2019. The result will be that even fewer small business owners and individuals – especially those who are very ill – will have access to affordable health care coverage.

With an administration that plainly cares more about abolishing Obama-era policy than it does about providing actual solutions for Americans, we’ll continue to lose not only our access to affordable health care, but we’ll also lose many of the regulations, such as environmental and food safety regulations, that were put in place to keep us healthy.

The issue of affordable and accessible healthcare (and the lack of it) has become like a can of worms that is not likely to disappear from the forefront. Many Americans who are insured through an employer, and/or who are perfectly healthy, are currently unable to see how this issue impacts their lives.

When more Americans, however, do feel the impact, whether from developing a serious and expensive illness, trying to obtain insurance with a pre-existing condition, or having a sick loved one without access to affordable healthcare, I predict that they will be wide open to the idea of a single payer or universal healthcare system – much to the dismay of the party who were its unwitting catalysts by dismantling the Affordable Care Act simply for the sake of doing so.

Trump Suspends Obamacare Risk Payments | Wochit News [2018-07-09]

Some payments halted for Obamacare program | Newsy | [2018-07-08]

Migrant Children: Leaving their Conditions for Worse Ones?

On April 26, 2018, Steven Wagner, an official at the Department of Health and Human Services (HHS), stated during a Senate Homeland Security subcommittee oversight hearing that HHS had lost track of 1475 migrant children in 2017. The migrant children had all been placed into HHS custody when trying to cross the Mexican border into the U.S, unaccompanied by adults.

When migrant children attempt to cross the border on their own, the Department of Homeland Security places them into the custody of the HHS Office of Refugee Resettlement (ORR), who provides them with food, shelter, clothing, and other necessities, until sponsors are selected and approved for the children.

Officials at HHS maintain that once the ORR places migrant children into the care of sponsors, it is no longer the responsibility of HHS to keep track of them. HHS did, however, follow up with a survey of over 7,000 of the migrant children, and this is apparently how they discovered that almost 1500 of them are unaccounted for.

According to Snopes, “From October to December 2017, HHS called 7,635 children the agency had placed with sponsors, and found 6,075 of the children were still living with their sponsors, 28 had run away, five had been deported and 52 were living with someone else. The rest were ‘missing,’ said Steven Wagner, acting assistant secretary at HHS.”

But this does not excuse the HHS’ complete lack of concern for following up on the safety and well-being of these children, which could be illustrated by Senator Rick Santorum’s comment on CNN’s State of the Union: “I mean, we lose people all the time in a lot of other government programs.”

Usually, a sponsor is a parent or other close family member, but sometimes, the sponsor is not related, or is a distant relative. When HHS releases migrant children to the care of sponsors, the children become the responsibility of the sponsors. On the one hand, with no oversight or follow-up from HHS, migrant children, if not in the hands of familiar and trusted relatives or family members, could be ripe for human trafficking.

Sen. Rob Portman (R-Ohio), chairman of the Senate subcommittee, in response to the revelation the HHS had lost track of 1475 migrant children, cited the case of a group of Guatemalan boys who had been forced to work on an Ohio egg farm after the HHS had released them to the care of human traffickers posing as family members (and hence approved as sponsors).

“These kids, regardless of their immigration status, deserve to be treated properly, not abused or trafficked,” Portman said in the subcommittee. “This is all about accountability. …We’ve got these kids. They’re here. They’re living on our soil,” he told PBS. “And for us to just, you know, assume someone else is going to take care of them and throw them to the wolves, which is what HHS was doing, is flat-out wrong. I don’t care what you think about immigration policy, it’s wrong.”

On the other hand, with the Trump administration’s no-holds-barred approach to undocumented immigration (including the recent announcement that the Justice Department would begin to prosecute 100 percent of those who attempt to cross the U.S.-Mexico border illegally), some feel that it’s not altogether bad that the HHS hasn’t caught up with all of the migrant children.

It’s possible that some of these migrant children and their sponsors have not responded to HHS calls because they have chosen to go “off the grid” in order to avoid the risk of deportation or prosecution. There are many other possible explanations for their “disappearance, including explanations as simple as an outdated phone number, or a decision not to answer the phone.

Whether we agree or not with the Trump administration’s policies regarding immigration, it is not ok to put any children, no matter what their status, at any level of risk for human trafficking. Just as true, though, is that undocumented migrant children are quite likely trying to flee a traumatic situation at home, and it is not ok, simply because we “can’t take on everyone in a difficult situation,” to subject these or any children to childhood trauma, whether through government negligence by formal policy.

Outrage over reports of ‘missing’ immigrant children – Daily Mail | Daily Mail [2018-05-28]

Federal Government Lost Track Of 1,500 Immigrant Children | Wochit Politics [2018-05-26]