What we know so far about the ‘HHS rule’ that could affect health care coverage for millions of Americans
Health care experts say the Trump administration’s proposal to rewrite a federal health care law that governs insurance policies in the U.S. is likely to create a significant disruption to the lives of millions of people and could have an even larger impact on the nation’s health care system.
The president’s health-care order is expected to go to the Senate, which has 52 seats, for consideration on Friday.
It would allow states to opt out of the requirement that they offer comprehensive coverage to people with pre-existing conditions, or to make the coverage more generous, or both.
If passed, the measure would be challenged in court by the American Medical Association, the American Hospital Association, and several states.
“I think it’s very likely to be defeated,” said Michael Cannon, who served as the president of the American Academy of Actuaries.
He added that the proposal was not based on an objective analysis of the existing insurance markets.
Critics of the Trump agenda say it could lead to the loss of insurance coverage for some people with health conditions, including high blood pressure, diabetes and cancer.
It could also force many people to lose insurance coverage they currently enjoy, or face higher premiums, or be penalized for buying insurance, said Daniel Wieder, a senior fellow at the American Enterprise Institute.
Under the proposal, states could allow insurers to charge sick people higher premiums or cancel policies they do not need.
Those who are unable to afford those increases could pay the difference in monthly premiums out of pocket, with no out-of-pocket cost for the insurer, said Brian Burlingame, president of health policy analysis firm Avalere Health.
As for the number of people covered by the health care plan, the administration said Friday that about 18 million people have signed up for the plans.
That number would be smaller if states opted to keep their coverage levels the same, the White House said.
In addition to offering subsidies, states would be allowed to set higher rates for insurance plans, which could be higher than those under current law.
States would be required to establish high-risk pools to help people with high medical expenses pay for coverage, including mental health services, drugs and prescription medications.
More than 200 states have enacted their own high-deductible plans for people with serious health conditions.
The federal government’s Medicaid expansion, the Children’s Health Insurance Program and other programs have helped fill in gaps in coverage for the poor and older Americans, according to the Kaiser Family Foundation, which advocates for people’s health.
However, the health plan could lead insurers to pull out of some of those programs and shift them to the high-cost, high-containment plans that are now available, said William H. Galston, a health policy expert at the nonpartisan Urban Institute.
The high-end plans would be more expensive than the low-end options.
Trump’s order also called for a “review” of how the health law is working for people in rural areas and other places that don’t have a health insurance market.
It said that the administration should examine how states can improve their systems and make sure people who do get health coverage have it, and it suggested that states could work to ensure that those who have health insurance can get it in a more cost-effective way.
Republicans have already expressed concerns about the health-insurance plan.
Senate Majority Leader Mitch McConnell, R-Ky., has said he will introduce legislation to address the issue in the Senate next week.
Trump has called the bill “mean-spirited.”
“It’s a plan that will hurt people,” McConnell said.
“We’re going to be spending a lot of time trying to figure out how to fix this.”
But Trump has also said that his plan is aimed at helping people with lower incomes who are struggling with high health costs, while offering them the best of the law and giving them more money to pay for their coverage.
“You can’t fix what’s not broken,” he said.