Sandy Dowland has been to the emergency room 10 times in the past year and was hospitalized during four of those visits. She has had a toe amputated and suffers from uncontrolled diabetes, high blood pressure, major depression, obesity and back pain.
But her health is not high on the 41-year-old woman’s priority list.
“I have a lot going on,” said the unemployed mother of five who lives in a homeless shelter. She said it’s a struggle just to get herself and children through each day.
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Federal officials will not block insurance companies from again using a workaround to cushion a steep rise in health premiums caused by President Donald Trump’s cancellation of a program established under the Affordable Care Act, Health and Human Services Secretary Alex Azar announced Wednesday.
The technique — called “silver loading” because it pushed price increases onto the silver-level plans in the ACA marketplaces — was used by many states for 2018 policies. But federal officials had hinted they might bar the practice next year.
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Some Republican lawmakers continue to try to work around the federal health law’s requirements. That strategy can crop up in surprising places. Like the farm bill.
Tucked deep in the House version of the massive bill — amid crop subsidies and food assistance programs — is a provision that supporters say could help provide farmers with cheaper, but likely less comprehensive, health insurance than plans offered through the Affordable Care Act.
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President Donald Trump has found one part of the federal health law palatable: He’s allowing Obamacare rules that require chain restaurants to post calorie counts to go into effect Monday.
The rules, which are among the final pieces of the 2010 Affordable Care Act to be implemented, require restaurants to list calories on all menus and menu boards. Restaurants will also have to provide on-site additional nutritional information, such as fat and sodium levels.
The law, intended to nudge Americans to eat healthier, applies to chains with at least 20 stores.
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Congress in 2017 failed to “repeal and replace” the Affordable Care Act. But the health law has been changed in many other ways over the past year and a half. Some changes were made by Congress, some by President Donald Trump and his administration and some by state officials. Here is a timeline of the most consequential events that have shaped the health law:
On his first day in office, Trump issues an executive order to “minimize the unwarranted economic and regulatory burdens” of the health law. It includes instructions to agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden.”
The same day, officials at the Department of Health and Human Services begin removing information on how to sign up for coverage from the healthcare.gov website, even though enrollment for 2017 policies lasts until the end of the month.
California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog.
In a Feb. 21 report, the HHS’ inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible, auditors found.
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Shopping to update your coverage on the health insurance marketplace may be annoying — didn’t you just do this last year? But letting the exchange automatically renew your coverage instead could be a big mistake. If you don’t like the plan you’re auto-enrolled in this year you may be stuck with it in 2018, unlike previous years when people could generally switch.
It’s all in the timing. This year, the open enrollment period, which started Nov. 1, will end a week from today, on Dec. 15 in most states. On Dec. 16, if you haven’t picked a new plan, the marketplace will generally re-enroll you in the one you’re in this year or another one with similar coverage.
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Health insurance a la carte?
As the Affordable Care Act open-enrollment season moves into its final weeks, some consumers looking for lower-cost alternatives are considering a patchwork approach to health insurance. The products may secure some basic protection but leave patients on the hook for high medical bills.
The idea involves mixing and matching several types of insurance products originally designed to cover the deductibles and other gaps in traditional coverage.
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Cyndee Weston can barely remember the last time she didn’t have to switch health plans during an Affordable Care Act sign-up season. By her count, she has been on five plans in five years.
Every fall, after she has spent months figuring out her insurance plan’s deductibles, doctor networks, list of covered drugs and other fine print, she receives notice that the policy will be canceled as of Dec. 31. Because her job doesn’t come with insurance, “it’s agonizing going through all the plans and trying to compare,” said Weston, 55, who has diabetes and a history of melanoma. “Every year it’s the same scenario: ‘We’re not going to renew your policy.’”
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Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care.”
Teri Goodrich of Raleigh, N.C., agrees. “We’re getting slammed. We didn’t budget for this,” she says.
Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved.
But one slice of the population, which includes Melquist and Goodrich, is unquestionably worse off. They are healthy people who buy their own coverage but earn too much to qualify for help paying their premiums. And the premium hikes that are being announced as enrollment looms for next year — in some states, increases topping 50 percent — will make their situations more miserable.
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