Since a Republican Congress has failed to repeal Obamacare, the Trump administration is doing it through the backdoor, and what they're doing will mean people with pre-existing conditions could lose their coverage. The thing that Trump and every Republican promised they wouldn't let happen.
The administration has issued new rules that will allow short-term policies—meant as inexpensive stop-gap coverage for a matter of weeks or months—to be extended to a full year, and is exploring making them renewable. These plans don't have to comply with the Affordable Care Act's essential health benefits and they can also deny coverage for pre-existing conditions.
"This all looks a lot like the landscape in 2013 [before the Affordable Care Act took effect]," said David Anderson, a research associate at the Margolis Center for Health Policy at Duke University whose work focuses on health insurance design.
Then there's Idaho, where the state has decided that insurers can ignore many of Obamacare's rules and sell what they're calling (of course) "freedom plans" that discriminate against sicker enrollees.
Typically, you'd expect the federal government to get involved—to step in and enforce federal law when a state refuses. But when pressed by a reporter on this issue Tuesday, HHS Secretary Alex Azar demurred.
"I'm not in a position to rule on something I've seen a media report about," he said, adding that he doesn't "believe in premature opinions on complex topics." […]
And Azar is the exact person who is in the position to act on Idaho. Traditionally, you'd expect the federal government to step in at this point and enforce a law when the state refuses. But so far, nothing has happened. Observers worry this could encourage other states to take similar steps, as they'll no longer fear federal interference.
"The thing that worries me is every single red state that wants to do something more aggressive is gonna leap at the opportunity," Nicholas Bagley, a law professor at the University of Michigan who is generally supportive of Obamacare, says. "We'll see a patchwork on the individual market every bit as profound as the disparity in Medicaid expansion."
Idaho has released its guidance. There's no reason for Azar to be relying on media reports about it—he can get the actual plan and probably would have by now if he had any intention whatsoever of intervening. Which he probably doesn't. One insurer—Blue Cross of Idaho—is moving ahead with selling these illegal plans, so if Azar did intend to do something, now would be the time.
That, and potentially the new rules from the administration on short-term plans, are definitely ripe for lawsuits. In the meantime, however, America needs to be aware that the thing they support most in Obamacare—never again being turned down for insurance for their pre-existing condition—is being systematically reversed by Trump.