1. The Affordable Care Act in 2018-2019: Implications for Montana
Katie Keith, JD, MPH
Georgetown University Law Center

2. 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”

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

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

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

6. Major Changes for 2019

7. 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 tax bill
Penalty still applies for 2018

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

9. “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

10. 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Most believe the ACA will be repealed
The majority did not know the mandate had been repealed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”

11. Potential OE6 Headlines?

12. “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Now that Congress repealed the mandate penalty, it is no longer a tax and is, thus, unconstitutional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

13. “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.

14. “’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)

15. Georgetown University Law Center
Thank you!
Katie Keith, JD, MPH
Georgetown University Law Center