Paul Shafer is an assistant professor of health law, policy, and management at the Boston University School of Public Health. Nicole Huberfeld is a professor of law and health law, policy, and management at the Boston University Schools of Law and Public Health. Follow them on Twitter at @shaferpr and @nhuberfeld1.
The Trump administration has had its hands full responding to the coronavirus pandemic, but that hasn’t stopped it from taking steps to reverse much of the gains in health insurance coverage since the Affordable Care Act was passed in 2010. In an article today on The Conversation, we discuss two major actions by the Trump administration that may would typically have made huge headlines but may have gotten lost in the COVID shuffle – 1) attempting to block grant Medicaid and 2) supporting a Supreme Court case that could take down the ACA.
Despite shaky legal footing, the administration has moved ahead with its Healthy Adult Opportunity guidance, issued to state Medicaid directors in January, that allows for states to opt-in to a per capita cap or program-level block grant for Medicaid. Oklahoma was going to be the first to implement this until a ballot initiative to expand Medicaid passed in July.
Block granting Medicaid has been a goal of Republicans for years, including during the ACA repeal efforts in Congress, but has never been able to be passed into law. This end run around federal law has been loudly challenged by legal scholars but is only one plank of the administration’s plans.
Texas v. California will be heard in November, a case in which 17 Republican-led states are trying to take down the ACA through again dubious legal arguments about severability of the individual mandate from the rest of the law. The administration has abdicated its role to defend the law and is arguing in favor of striking it down, trying to accomplish through the courts what it has failed to do through Congress.
As we wrote,
If the ACA is struck down, that means the loss of coverage for preexisting conditions, the return of annual or lifetime caps, or policies being revoked for cancer patients. Those who don’t earn much money still deserve good health care. Nearly everyone will feel it if the Trump administration and Texas are successful, regardless of whether your health insurance is through your work, HealthCare.gov, Medicaid or Medicare.
This fall, the Supreme Court and the voters will have a lot to say about how access and affordability of health insurance coverage look in 2021 and beyond.
Read the whole piece here.
Research for this piece was supported by the Laura and John Arnold Foundation.
