State governments that support Obamacare are resisting efforts by the Trump administration and Congress to scale back the law, and are moving to either expand it or reinstate provisions that were rolled back.
While many red states have tried to loosen Obamacare rules or offer their residents less expensive alternatives, blue states in particular are stepping in with their own proposals. They are re-implementing policies that the Trump administration is trying to gut, or looking to go further to involve the government in health insurance.
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Their ideas go beyond expanding the government-funded Medicaid program to low-income people or setting up reinsurance funds to pay for high-cost medical claims, though those proposals are on the table in several states as well.
Here are five examples of ways states are looking at expanding Obamacare to further reduce the number of people who are uninsured.
1) Allowing pregnancy to trigger a ‘special enrollment period’
The Connecticut legislature has sent a bill to Democratic Gov. Dannel Malloy that would let uninsured women enroll in Obamacare outside of the normal open enrollment period.
Under Obamacare, women who are uninsured or on Medicaid can enroll in Obamacare within 60 days after childbirth, regardless of whether it’s enrollment season, but the same is not true when they find out they are pregnant. In Connecticut, pregnancy would join the list of other life events that allow people to sign up outside of open enrollment, including a move, divorce, or marriage.
Under the bill, a woman would have 30 days to enroll in an Obamacare plan after learning from a doctor or nurse that she is pregnant. Malloy has until June 6 to sign or veto the bill, and if he does nothing it will go into effect. New York is the only other state that has a similar law on the books.
2) Extending Medicaid to people residing in the state illegally
A proposal is gaining steam by Democrats in California to allow all adults, regardless of immigration status, to enroll in Medicaid, a program for low-income people that is paid for by the government.
It would cost the state $3 billion a year to cover the 1.3 million people who would qualify, and critics worry that more people will head to the state if the provision goes into effect. Supporters counter that the state is already swallowing medical costs associated with paying for emergency care in hospitals. California already allows all children in the state to receive medical coverage regardless of immigration status.
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The state had sent in an Obamacare proposal to the administration when former President Barack Obama was in office to allow people in the country illegally to buy private medical coverage on the exchange, though without receiving subsidies. It withdrew the bid when Donald Trump was elected president.
3) Bringing back Obamacare’s penalty on the uninsured
New Jersey lawmakers have approved a plan to bring back the individual mandate, the unpopular provision in Obamacare that obligates most people purchase health insurance or pay a fine.
Beginning in 2019, the fine will zero out due to a provision in the Republican tax bill signed into law late last year by President Trump. Though the exact effect of the mandate has been a point of debate, certain enrollees are expected to drop out of the exchanges as a result of the repeal, particularly if they are younger, healthier, and do not receive federal subsidies, and feel that they would rather take the risk of being uninsured than pay high premiums.
As a result, more sick people would be left in the pool, resulting in average premiums increases of between 10 and 15 percent. Though other states that are supportive of Obamacare have proposed bringing the mandate back, New Jersey is the state that has come closest, and Massachusetts had its own mandate before Obamacare, so it remains in place.
The fine is $695 per person or 2.5 percent of income, whichever is higher. Under the New Jersey plan, which is awaiting Democratic Gov. Phil Murphy’s signature, the money for the fine goes into a pool that helps pay medical claims of people who are very ill.
4) Limiting short-term health insurance
The Trump administration has moved to roll back a rule implemented toward the end of Obama’s term that limited the amount of time people were allowed to be enrolled in short-term health insurance plans. The government has proposed to let people stay in short-term plans for a year, while the Obama administration had cut the plans to three months.
For some consumers, these plans will be less expensive, but they will also offer fewer consumer protections and not everybody will be able to enroll in them because they can be turned away due to health status.
Several states have reacted to the Trump administration proposal by placing their own limits on short-term plans. Maryland echoed the Obama administration’s policy by setting a three-month limit. California’s Senate has advanced a bill that would ban the sale of short-term plans beginning in 2019, and a bill in Hawaii would have a similar impact.
5) Allowing more people to enroll in Medicaid
Billed as a state “public option,” a handful of states are considering legislation that would allow more people to buy into Medicaid.
The Medicaid plans would compete directly with the private health insurance plans that are sold on the exchanges, and would likely be less expensive but would also reimburse doctors and hospitals at a lower rate. The proposal got furthest in Nevada last year, but was ultimately vetoed by Republican Gov. Brian Sandoval, who said more research was needed.
The Massachusetts Senate passed a bill in November to allow a Medicaid buy-in, and New Mexico has set up a task force to study the possibility. Other bills have been introduced in Iowa, Minnesota, Missouri, New Jersey, and Washington.
