On Thursday, October 12, 2017, the Administration took two actions on health care that could affect coverage for people who have health insurance through the exchanges.
特朗普总统签署了一项行政命令，为扩大联合医疗计划打开了大门，这些计划不受《平价医疗法案》(ACA)要求的患者保护水平的相同水平。其次，政府宣布停止成本分担削减付款，这是向健康保险公司支付的款项，帮助在健康交易所购买保险的低收入者减少自付费用。
继续阅读，了解更多有关政府的行动及其对关节炎社区的潜在影响。
Let’s start with the executive order.
Does the executive order have any immediate effects on the health care system?
No. The executive order asks relevant federal agencies, such as the Department of Health and Human Services, to change how some health care regulations are interpreted. It is important to understand that the executive order does not have an immediate legal effect on the health care system. Any changes would require federal agencies to issue new regulations and accept public comments about any proposed changes. This process could take several months.
What kind of changes are proposed in the executive order?
The executive order seeks to make three key changes. It would increase flexibility of association health plans; expand the definition of short-term health insurance plans; and enhance health savings account (HSA)-type plans.
What are association health plans?
协会健康计划是在ACA通过成为法律之前就存在的一种计划。这些保险是由一群小企业共同购买的。其理念是，通过作为一个统一的集团行动，这些小企业可以发挥大企业的购买力。
允许小企业发挥更多的购买力听起来是个好主意。缺点是什么?
ACA计划必须为已有疾病的人提供基本的健康福利和保护，而联合健康计划不受同样的要求。在这些计划下，基本健康福利可能不那么全面，对已有疾病的人的保护也可能被取消。
What about short-term health plans?
个人可以在短时间内购买这些类型的保险，目前不超过三个月。与传统的健康保险计划相比，这种保险计划往往有更高的自付费用，提供的服务也更少。这是因为这些保险计划是临时性的。然而，在ACA之前，这些计划的持续时间最长可达一年。行政命令将短期计划从三个月延长到一年;这些计划不需要提供全面的保险。
健康储蓄账户(HSA)类型的计划将会发生什么变化?
Healthcare.govdefines HSAs as a type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. An HSA can be used only if you have a High Deductible Health Plan (HDHP). The executive order could permit people to use funds from these plans to help pay for their premiums on the individual market. This policy is similar to what Congress included in several health reform bills last summer.
Now let’s talk about the cost-sharing reduction subsidies. Following President Trump’s executive order, the Administration made the decision to immediately discontinue ACA cost-sharing reduction (CSR) payments.
What are cost-sharing reduction (CSR) payments? Why did the administration stop them?
根据healthcare.gov网站，csr是降低免赔额、共同支付额和共同保险金额的折扣。当你在开放登记期间填写申请表时，你就会知道你是否有资格获得这些付款。
In its announcement discontinuing the payments, the administration cited a legal opinion from the Department of Justice, which determined that the CSR payments were illegal because Congress did not allocate funding for the payments.
How will the discontinuation of CSR payments affect my health care plan?
If you qualify for these payments, the choices available to purchase health insurance could be more limited. This is because health insurers, who rely on these payments to lower an individual’s premiums, could decide not to participate in the exchanges. Another potential consequence is that some individuals may see their premiums increase. In either case, the impact depends on the state you live in.
Is there anything a state can do to address the discontinuation of CSR payments?
Following President Trump’s announcement on Friday that he was discontinuing the CSR payments, 19 Democratic Attorneys General filed a lawsuit in federal court in California to block the decision. It remains to be seen how this litigation will move forward.
What can Congress do to address the discontinuation of CSR payments?
On Tuesday, October 17, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced a tentative bipartisan agreement to continue the CSR payments for two years and provide states increased flexibility. It is unclear whether this agreement will have enough support in Congress to pass into law.
Do the announcements by the administration change this year’s open enrollment for exchange plans?
No. The open enrollment process will remain the same. Open enrollment for federal exchange plans begins on November 1 and ends on December 15.
What is the Arthritis Foundation doing about these two announcements?
关节炎基金会致力于确保关节炎患者获得高质量、负担得起的医疗保健，并受益于《负担得起的医疗法案》所要求的患者保护。我们签署了反对这两项声明的声明，并将敦促国会通过两党立法，继续支付CSR费用。
We welcome your feedback and questions atadvocacy@arthritis.org，并希望你知道你可以随时使用关节炎基金会作为资源。我们在这里支持你。
Related Resources:
- Arthritis Foundation Advocacy News & Regulatory Letters
- Senate Health Bills Fall Short for Arthritis Community
Updated Oct. 18, 2017