In a recent New York Times interview, President Trump was quoted as saying the following regarding health plans:

“So now I have associations, I have private insurance companies coming and will sell private health care plans to people through associations. That’s gonna be millions and millions of people. People have no idea how big that is. And by the way, and for that, we’ve ended across state lines. So we have competition. You know for that I’m allowed to [inaudible] state lines. So that’s all done.”

Health policies in 2018 – 5 Predictions

Obamacare revisits

The fate of health policies is still relatively uncertain in 2018, with many people wondering if the Trump administration will continue to rollback Obama-era policies. Congress is said to be revisiting Obamacare this year, and it’s pretty likely that they will attempt a major overhaul of Obamacare in 2018.

Axios’s Sam Baker recently suggested that the tax bill increases the likelihood that the Republicans will work on healthcare-related policies this year. It is thought that repealing the individual mandate could negatively affect some state marketplaces, with insurers being reluctant to sell in places where fit and healthy people don’t have to buy coverage plans.

States trying to pass individual mandates

In response to new tax laws that no longer require American citizens to buy health insurance coverage, it is likely to many states attempt to pass state-level mandates in order to put this back into effect. Maryland, California, Washington State and the District of Columbia have already made noise about this. Though these efforts may not always work, it’s thought that some states may attempt to incentivize their citizens to buy insurance in other ways, such as via fines and higher premiums.

Big Medicaid changes

About six states want to make big changes to Medicaid policies. Medicare administrator Seema Verma has been reviewing these waivers for some time now, though she tends to support the changes the states want to make. In a recent speech at the National Association of Medicaid Directors, she has this to say:

“For people living with disabilities, CMS has long believed that meaningful work is essential to their economic self-sufficiency, self-esteem, wellbeing, and improving their health. Why would we not believe that the same is true for working-age, able-bodied Medicaid enrollees?

Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration. Those days are over.”

It looks likely that these waivers will be approved this year and that Medicaid will see some serious overhauls. It seems very likely, for example, that low-income Americans will be required to work in order to receive their federal health care benefits.

CHIP “may” get funded

States’ health programs for low-income kids may very well be shut down (or suddenly funded) in 2018. Its future very much hangs in the balance, though repealing CHIP would not exactly be a good PR move for state and federal governments.

CHIP has been a bipartisan health care program historically, something which cannot be said about the somewhat contentious Affordable Care Act. Though Senator Orrin Hatch (R-UT), who chairs the influential Senate Finance Committee, is a big CHIP supporter, its future remains unclear.

Health insurance expansion is tested out by a state

Liberals seem keen to expand public health coverage, especially with continued Republican efforts to repeal the Affordable Care Act. Democratic senators, for example, are continually supporting a Medicare-for-All bill. State legislatures are also being watched though, with some states expressing interest in finding ways to expand public health coverage.

Nevada, for example, nearly enacted the US’s first Medicaid buy-in, which would’ve allowed Nevada state residents to buy coverage through the program which is usually limited only to low-income American citizens. Their plan passed the Nevada legislature, though Governor Brian Sandoval, a Republican, vetoed it.

Medicaid buy-ins are gaining steam, however, as candidates in states such as Colorado and Connecticut campaign by promoting the notion of Medicaid buy-ins to voters who may want them. State legislators in Washington State are also said to be exploring a Nevada-esque buy-in bill.

States tend to act as experiment grounds for health policies, with many states often “testing out” policies that may or may not be looked at by the federal government in time to come. The Affordable Care Act, for example, was largely based on the Massachusetts 2006 health care expansion. It seems like Nevada-esque bills may become more and more common in the near future, as the federal government looks for state “experiments” to model potential nationwide healthcare policies on.

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