The Affordable Care Act in 2018-2019: Implications for Montana Katie Keith, JD, MPH Georgetown University Law Center katie.keith@georgetown.edu

Where We Are Today Relative stability Enrollment Premiums Insurer Participation National trends versus Montana trends Source: U.S. Census Bureau, “Health Insurance Coverage in the United States: 2017”

Source: Christina Goe, “2018 Report on Health Coverage and Montana’s Uninsured”

Source: Christina Goe, “2018 Report on Health Coverage and Montana’s Uninsured”

Another Trend: States Fill Gaps State-level individual mandates Reinsurance programs State-based marketplaces

Major Changes for 2019

Repeal of the Individual Mandate for 2019 No more mandate penalty, beginning in Jan. 2019 Beginning next year, individuals who are uninsured will no longer pay a tax penalty Penalty was changed to “$0” during Dec. 2017 tax bill Penalty still applies for 2018

Source: Kaiser Family Foundation, “Kaiser Health Tracking Poll – March 2018: Non-Group Enrollees”

“New” Coverage Options More access to plans that don’t have to comply with the ACA’s rules – “association health plans” and “short-term plans” New regulations make it easier to buy plans that do not follow the ACA’s rules May not cover essential health benefits, may charge higher premiums or deny coverage because of someone’s gender, age, or other factors

Enrollment Messaging Things That Remain the Same New Insights Most have looked for health insurance at one point or another Cost is the main barrier to coverage Most are unaware of the tax credit Uninsured individuals feel insecure without insurance Those who enrolled really wanted coverage and found it affordable Assisters were key to enrollment The uninsured want help New Insights Most believe the ACA will be repealed The majority did not know the mandate had been repealed None knew that navigator and advertising funding had been cut Many had not heard of new “skinny” plans Some are giving up Source: PerryUndem & gmmb, “Open Enrollment 2019: Insights from Focus Groups with Uninsured and Marketplace Consumers”

Potential OE6 Headlines?

“Court strikes down the ACA, finds the law is unconstitutional” Texas v. U.S. – 20 Republican AGs/Governors sued the Trump administration to invalidate the entire ACA Their argument: In 2012, the Supreme Court upheld the individual mandate as a tax Now that Congress repealed the mandate penalty, it is no longer a tax and is, thus, unconstitutional If the mandate is unconstitutional, the entire ACA—all 1,000 pages—should also be struck down Department of Justice partially agrees  asked court to strike down the mandate, guaranteed issue, community rating, and preexisting condition protections Impact: uninsured would increase by 17.1 million (50%) nationwide, more uncertainly

“Trump administration ordered to stop sabotaging the ACA” Maryland v. U.S. and Columbus et al. v. U.S. – MD AG and four cities separately sued the Trump administration for undermining the ACA Their argument: Trump administration is intentionally undermining the ACA and trying to “repeal” the law without Congress  cuts to advertising and navigators, “new” coverage rules, executive orders, etc. Federal officials must follow the ACA as written Impact: confirm that the ACA is constitutional and reverse the “sabotage” activities  fund navigators and outreach and enrollment, etc.

“’New’ coverage options touted by Pres. Trump invalidated in court” New York v. Dept. of Labor and Association for Community Health Plans et al. v. Dept. of Treasury – Democratic AGs and consumer advocates separately sued the Trump administration for new rules on association health plans and short-term plans Their argument: New rules are inconsistent with the ACA Federal agencies have gone too far by expanding these rules New rules will burden states and hurt consumers Impact: delay/stop the new rules on association health plans and short-term plans (unlikely to occur before Nov. 1st)

Georgetown University Law Center Thank you! Katie Keith, JD, MPH Georgetown University Law Center katie.keith@georgetown.edu