President Donald Trump promised in January to replace the Affordable Care Act with a plan to provide “insurance for everybody” at lower cost. But in recent days, he has ensured that health insurance will soon be unaffordable for many who buy individual policies.

Less than three weeks before the start of the open enrollment period for 2018, the Trump administration announced that the federal government will no longer provide some $7 billion in cost-sharing reduction payments to health insurance companies. That decision “could cause chaos in insurance markets, sending insurers fleeing from the Affordable Care Act’s marketplaces, raising the federal government’s costs and pricing out some consumers.” Former presidential adviser Steve Bannon told the Values Voters summit on October 14 that pulling the cost-sharing reductions would “blow those exchanges up.” The conservative crowd cheered when Bannon praised Trump’s action to destabilize health insurance markets.

Hours before axing the cost-sharing payments, the president had signed an executive order “expanding lower-cost insurance options,” which “could result in more bare-bones coverage and pull healthier people out of the already struggling insurance markets.”

Trump’s latest actions don’t necessarily doom the “stopgap plan” Iowa officials have proposed to lure Wellmark Blue Cross/Blue Shield back to the individual insurance market for 2018. Tony Leys reported for the Des Moines Register that the Iowa Insurance Division had already revised its waiver request so as not to rely on redirecting roughly $48 million in cost-sharing reduction payments that went to Iowa insurance companies this year.

The Iowa Democratic Party is seeking public records to find out how hard Governor Kim Reynolds and her staff have worked to secure approval of the “stopgap” plan, supposedly a high priority for her administration. Trump has reportedly instructed officials to reject Iowa’s waiver. I enclose below details on the Democratic Party’s records request and clips on this week’s health care policy developments.

In theory, the 72,000 Iowans who purchase individual insurance policies should be able to buy a policy for next year. Medica is prepared to sell individual insurance statewide if the stopgap plan is rejected, Iowa Insurance Division communications director Chance McElhaney told me this week. If federal officials grant Iowa’s waiver request, then Wellmark will sell policies statewide, and Medica will provide competition in certain counties.

In either scenario, those plans will have higher premiums, so thousands of consumers will be priced out of the market. The insurance division believes more people will go uninsured without the stopgap plan.

The latest moves are among at least twelve ways the Trump administration has tried to undermine the Affordable Care Act. The federal government is cutting funds for non-profit “navigators,” on whom many consumers rely to help sign up for insurance or renew their policies. A 90 percent cut to spending on advertising and outreach funds will eliminate all television commercials informing people how to sign up for health insurance. Market research proved tv ads were the number one driver of enrollment, according to Lori Lodes, who ran outreach for the ACA during the Obama administration. Most people don’t know the enrollment dates, which will be only a 45-day window this fall, compared to 90 days in previous years.

Meanwhile, the Healthcare.gov website will be offline for 12 hours almost every Sunday during the enrollment period. That planned downtime is way beyond what’s needed for website maintenance. Iowans who qualify for subsidies through the Affordable Care Act need to use Healthcare.gov to buy individual policies, because Republican state lawmakers and Governor Terry Branstad refused to set up a state-based health insurance exchange.

This is an open thread: all topics welcome.

From an October 12 New York Times story by Robert Pear, Maggie Haberman, and Reed Abelson:

With an 1,100-word directive to federal agencies, the president laid the groundwork for an expanding array of health insurance products, mainly less comprehensive plans offered through associations of small employers and greater use of short-term medical coverage. […]

Most of the changes will not occur until federal agencies write and adopt regulations implementing them. The process, which includes a period for public comments, could take months. That means the order will probably not affect insurance coverage next year, but could lead to major changes in 2019. […]

“This is going to be something that millions and millions of people will be signing up for,” the president predicted, “and they’re going to be very happy.”

But many patients, doctors, hospital executives and state insurance regulators were not so happy. They said the changes envisioned by Mr. Trump could raise costs for sick people, increase sales of bare-bones insurance and add uncertainty to wobbly health insurance markets.

Chris Hansen, the president of the lobbying arm of the American Cancer Society, said the order “could leave millions of cancer patients and survivors unable to access meaningful coverage.”

In a statement from six physician groups, including the American Academy of Family Physicians, the doctors predicted that “allowing insurers to sell narrow, low-cost health plans likely will cause significant economic harm to women and older, sicker Americans who stand to face higher-cost and fewer insurance options.”

From Julie Appleby’s October 12 story for the Kaiser Health Network on Trump’s executive order:

The executive order directs many agencies, including the Department of Labor, to consider proposing rules or new guidance to loosen current restrictions on what are called “association health plans” and on selling low-cost, short-term insurance.

Such rules could potentially exempt such plans for a number of the requirements of the Affordable Care Act. […]

Associations are generally membership groups based on a profession or business. Proponents say allowing consumers to buy insurance through these organizations gives them more clout with insurers than they’d have buying their own plan on the individual market — and results in lower premiums.

But the real savings in premiums is likely to come because the policies could offer fewer benefits than more regulated ACA plans, and the associations would have more leeway to set premiums based on the health of the group. […]

Some consumer advocates also warn that association plans and short-term policies are generally less generous with benefits — and could leave some unwary consumers stuck with large medical bills. Such plans might not cover maternity care, for example, or prescription drugs.

Additionally, short-term plans can exclude paying for any preexisting medical conditions, either upfront or upon renewal, something the ACA bars for all other types of insurance.

From an October 13 story for the Des Moines Register by Tony Leys:

Iowa’s individual health-insurance market has been rocked by instability, with just one carrier planning to sell such coverage here for 2018. That carrier, Medica, raised its proposed premium increase from 43 percent to more than 57 percent in August, after Trump threatened to cut off the cost-sharing payments.

Iowa health insurers are receiving about $48 million in such payments this year, state officials say. This summer, Iowa Insurance Commissioner Doug Ommen proposed redirecting that money and the more than $300 million in Obamacare premium subsidies in a “stopgap” proposal that he said would shore up the state’s individual insurance market. But Ommen’s office later altered the proposal in a way that would no longer rely on any cost-sharing money for 2018. […]

State leaders noted Trump’s new move wouldn’t cancel Obamacare’s separate premium subsidies, which would be the main source of money for the stopgap proposal. “This decision by the federal government does not impact Iowa’s stopgap measure one way or the other,” Brenna Smith, spokeswoman for Gov. Kim Reynolds, said in a statement to reporters Friday.

Iowa Democratic Party press release, October 11 (emphasis in original):

Iowa Democratic Party Files FOIA to Hold Reynolds Accountable for Health Care Failure

Des Moines, IA – Today, the Iowa Democratic Party filed a FOIA to hold Governor Kim Reynolds accountable for her broken promise on health care and shed light on the health care negotiations between Reynolds and President Donald Trump.

Despite Governor Reynolds’ public promise to advocate for Iowa’s stopgap insurance plan directly to the President, Reynolds admitted on Tuesday that she had not discussed the issue with him directly.

The Iowa Democratic Party is calling on the Reynolds Administration to release all records of communication between the Office of the Governor, the Office of the Lieutenant Governor, or Iowa Insurance Commissioner Doug Ommen and President Donald Trump, Department of Health and Human Services Secretary Tom Price, CMS Administrator Seema Verma, or any employee of HHS or CMS from May 1, 2017 through today.

This FOIA will help get to the bottom of whether and how the Reynolds Administration has been working with the Trump Administration on this critical issue by furnishing records of all communication between the two.

“Governor Reynolds admitted she failed to advocate for our state when she met with the President, and now, healthcare for tens of thousands of Iowans is at risk,” said Iowa Democratic Party Executive Director Kevin Geiken. “With so much dysfunction both here in Des Moines and in D.C., Iowans deserve complete transparency from our current Governor and the White House. Neither has owned up to that responsibility, so the Iowa Democratic Party is trying to get to the bottom of this mess with this FOIA request.”

The text of the FOIA is below:

Kevin J. Geiken
Executive Director
Democratic Party of Iowa
KGeiken@iowademocrats.org

October 11, 2017

Colin Smith
Deputy Legal Council [sic]
Office of the Governor of Iowa
Colin.Smith@iowa.gov

Dear Mr. Smith:

Under the Iowa Open Records Law § 22.1 et seq., I hereby request the Office of Governor Kim Reynolds produce the following public records within ten (10) business days, pursuant to Section 22.8(4)(d) of the Iowa Code:

Any and all records and correspondence from May 1, 2017 through the date this request is received, including by not limited to emails, faxes, records of phone calls, invoices, or text messages, between the Office of the Governor, the Office of the Lieutenant Governor, or Iowa Insurance Commissioner Doug Ommen and President Donald Trump, Department of Health and Human Services Secretary Tom Price, CMS Administrator Seema Verma, or any employee of HHS or CMS.

As records kept by the Office of the Governor, the requested records qualify as “public records” under the Iowa Open Records Law and should accordingly be turned over within ten (10) business days. If access to the public records I am requesting will take longer, please contact me with information about when I might expect copies or the ability to inspect the requested records.
If there are any fees for searching or copying these records, please inform me if the cost will exceed $50. This information is not being sought for commercial purposes.

If you deny any or all of this request, please cite each specific exemption you feel justifies the refusal to release the records and notify me of the appeal procedures available to me under the law.

Thank you for considering my request and I look forward to hearing back from you within ten (10) business days.

Sincerely,
Kevin J. Geiken