Health care and prescription drug plans have become the new battleground in the battle over the Affordable Care Act, with insurers seeking to undermine the law’s expansion of coverage to more people by offering plans that do not meet the law.
The new threats include a proposed rule from the Trump administration that would allow insurers to opt out of the ACA’s insurance expansion, the American Health Care Act (AHCA), and a rule from Congress that would require insurers to charge higher premiums to older people and people with pre-existing conditions.
“It is important to remember that, when the ACA was passed, there were only a handful of insurers offering coverage in most states,” said Karen Pollitz, president and CEO of the American Association of Retired Persons.
“As of now, the ACA has expanded coverage to nearly half of Americans, and those with pre or severe medical conditions are being protected from skyrocketing premiums.”
The new threat from insurers comes amid growing public concerns about how the ACA will impact the insurance marketplaces, where the new health plans are being offered.
The law was passed in 2010 and expanded coverage for people with insurance in many states.
That law also expanded the federal government’s role in the marketplaces.
That meant insurers were required to offer coverage to everyone in the individual market, with the government picking up the tab for the cost of the individual plans.
Insurers had to cover about 20 percent of all Americans with income below about 138 percent of the federal poverty line (about $25,945 for a single person) before the federal tax credits for lower-income Americans went into effect.
The ACA also gave insurers the option of selling their plans across state lines.
The federal government reimbursed insurers that offered plans that did not meet that requirement for up to 50 percent of their costs.
But that allowed insurers to exclude people with preexisting conditions from the plans and said insurers were still allowed to exclude some older and sicker people from the market.
The Obama administration had said the rules should apply to all plans sold in the new marketplace.
The Trump administration proposed a rule on Thursday that would overturn the mandate that insurers offer coverage and allow insurers the choice of selling policies across state boundaries.
“There’s a lot of people that are not happy with the ACA,” Pollitz said.
“I don’t think that will change.”
She said that if the Trump plan becomes law, “the risk to people with high incomes and high health needs is much higher than it was before.”
Pollitz pointed to the possibility that insurers could sell plans that offer high deductibles and other features that make them less affordable to younger and healthy people.
The Congressional Budget Office estimated that under the proposed rule, the cost to people without insurance could increase by about 20 percentage points by 2026 if they do not have coverage through the marketplace.
“That is a big chunk of people who are not in the exchanges are not covered, and that is a risk to the stability of the markets,” Pollits said.
In some states, insurers will be able to offer more coverage.
States like New York, Colorado, Texas and Connecticut have already passed legislation allowing insurers to offer health plans across states.
But many others have not, including Minnesota, North Carolina, Virginia, Kentucky and New Mexico.
Pollitz told USA TODAY that if states do not expand coverage for older and younger people, insurers could offer plans that exclude people from their market, which could have a chilling effect on the health insurance market.
“The insurance market is going to become more unstable,” Pollith said.
Polls conducted earlier this month showed that a majority of Americans support expanding coverage to all people, even if that means paying higher premiums.
Polling by the Kaiser Family Foundation shows support for that plan has increased from 43 percent in April 2016 to 65 percent in May 2017.
Pollts group of advocacy groups is pushing for the government to expand insurance coverage across the country, as well as for states to expand the number of health insurance exchanges that will offer coverage.
“People should be able have coverage regardless of their age, income or where they live,” Pollitts group said in a statement.
“We want states to be able and willing to expand coverage in their areas, and not be restricted by the ACA rules.”
This story was produced by Kaiser Health News, a nonprofit health care news service, as part of the Kaiser HealthNews initiative.