Actions Toward Health System Change 2017


Repealing and revising federal health law associated with the provisions of the Affordable Care Act is a primary declared goal of the Trump Administration and Congressional Republican leaders in 2017.

The question states are asking is how the results of this policy effort will impact their health insurance markets and their Medicaid programs. In an effort to keep NCSL members informed about the process as it progresses, this web page will serve as a landing page links to NCSL web pages regarding the new developments and resources. 

Executive Branch Activities 

Trump Administration Cancels Health Insurance Payments

Last fall the Trump administration announced that it would be discontinuing Cost Sharing Reduction (CSR) payments that are intended to reduce out-of-pocket health care costs for low-income Americans who obtain their healthcare through the ACA. The payments have been part of an ongoing debate between the administration and Congress on whether the payments should be approved by the White House or appropriated by Congress.

The CSR payments, which cost about $7 billion in 2017, alleviate copays and deductibles for people with lower incomes who purchase insurance through the healthcare exchanges established by the ACA. According to the Kaiser Family Foundation (KFF), 57 percent of people that have obtained their health insurance in the marketplace qualified for cost sharing subsidies. Should the payments cease, which is still a question considering that multiple groups, including 18 states and the District of Columbia, filed suit against the administration almost immediately after the announcement, the KFF expects that insurers would have to raise premiums by approximately 19 percent to make up for the loss of the government's payments.

Also last week, the administration signed an executive order (EO) that proposes changes to the health insurance market. The EO touches on; association health plans, short-term limited duration plans and health reimbursement arrangements. The administration has expressed concern that many Americans only have access to one or two providers, and these proposed changes could expand their networks.

For an overview of both the executive order and the CRS payment announcement.  NCSL Contact: Haley Nicholson, Policy Director, Health, State-Federal Affairs, Washington, D.C.

Messages to States from the Department of Health and Human Services 

Activity in the 115th Congress

Blueprint Proposals for Medicaid