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The State Of The Affordable Care Act


It is no secret that Republicans are not fans of the Affordable Care Act. Last year, they tried and failed to repeal the health care law. And ever since, they've been carving away at it piece by piece. Last December, Congress eliminated the penalty for not having health insurance, effectively getting rid of the mandate that many Republicans despised. And in the spring, President Trump issued new rules making it easier for people to buy cheaper insurance that covers fewer health care services. And now this month, the administration has gone even further. Here to tell us all about it is NPR's Alison Kodjak. Good morning.


MONTAGNE: What did the president do this month exactly?

KODJAK: So he took two actions, the administration. The Department of Health and Human Services cut the funding for these nonprofit groups that are known as navigators that help people choose their health insurance plans. And then secondly, they suspended what's known as the risk adjustment program, which is a pretty wonky program, but it helps to smooth the bumps in the market for insurance companies.

MONTAGNE: OK. Let's start with those navigators you spoke of. Now, in what way have they been considered quite necessary?

KODJAK: So the navigators give people in-person one on one help to help choose a health plan and to sign up. And, you know, health insurance is very confusing. There's deductibles. There are the premiums. There are copayments, so it's really hard to know what services you're going to get and what it's really going to cost. But HHS says after several years, they aren't really necessary anymore because now people understand insurance better, so they don't need that kind of intensive help. Navigator defenders, though, don't agree because they say now their role is to get to those people who still after all these years haven't gotten insurance.

MONTAGNE: The ones that in a way are most confused...

KODJAK: Exactly.

MONTAGNE: ...And hard to reach.

KODJAK: Hard to reach.

MONTAGNE: OK. So they cut dramatically this navigator budget, and then the administration also froze risk adjustment payments to insurance companies. Tell us about that.

KODJAK: What the risk adjustment program is is some insurance companies have a lot of healthy people on their plans, and they don't have to spend a lot on health care where other companies might have way more sick people and have a lot more health care costs. So some companies pay in and that money goes to the companies that have to spend a lot on health care to smooth out the program. The term administration just decided not to make those payments. And these insurance companies really plan ahead. They depend on getting those payments when they determine what their policy prices are going to be. So this action is likely to lead to higher prices.

MONTAGNE: So what's the big picture here, Alison? I mean, what does it mean to have fewer navigators and no mandate and to allow cheaper plans?

KODJAK: Even with all these changes, the markets really aren't likely to collapse. And that's because of the federal subsidies. Insurance companies - they're going to raise their premiums on their policies, but low and middle-income people who get those subsidies to help pay their premiums, they're going to be protected, and they'll likely stay in the market because when premiums go up, the subsidies go up. So insurance companies are also protected because they're still going to get that money from the federal government. But the people who are likely to get hurt are the people who make more money, don't qualify for those subsidies. Those could be people with middle incomes and a little bit higher and people who run small businesses and have to buy their own insurance because they don't get it from their employer. The ironic thing is a lot of those people are the ones who don't like Obamacare and likely voted Republican in the first place. And they're the ones that all these actions are going to affect the most.

MONTAGNE: Overall, though, Alison, are the exchanges doing well? Because people are signing up.

KODJAK: Yeah. People are still signing up, or at least last year's enrollment was just as strong as the year before. And people who get subsidies are likely to want to keep that insurance and they can afford it. So they'll probably keep signing up.

MONTAGNE: NPR's Alison Kodjak, thanks very much.

KODJAK: Thank you, Renee. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.

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