Democrats
recently
notched
a
win
when
it
comes
to
the
Affordable
Care
Act
Marketplaces.
A
federal
district
judge
in
Baltimore
issued
a
stay
in
August
on
several
provisions
of
the
Trump
administration’s
Marketplace
Integrity
and
Affordability
Rule.
The
rule
aimed
to
reduce
fraud,
waste
and
abuse
in
the
Affordable
Care
Act
Marketplaces,
but
would
have
also
led
to
significant
coverage
losses
(up
to
1.8
million
people).
It
would
tighten
eligibility
verifications
for
ACA
plans,
shorten
the
annual
open
enrollment
period,
and
prohibit
subsidies
to
ACA
plans
for
gender-affirming
care,
among
other
changes.
U.S.
District
Judge
Brendan
Hurson’s
decision
came
just
a
few
days
before
the
rule
was
supposed
to
take
effect.
The
lawsuit
challenging
the
rule
was
filed
by
the
cities
of
Columbus,
Baltimore
and
Chicago,
as
well
as
Doctors
for
America
and
Main
Street
Alliance
(a
network
of
small
business
owners).
They
argued
the
rule
violates
the
Administrative
Procedure
Act,
which
governs
the
process
by
which
federal
agencies
can
create
regulations.
The
court
found
that
the
plaintiffs
would
likely
succeed
on
their
challenges
to
several
provisions.
Democracy
Forward,
a
legal
organization
that
represented
the
plaintiffs,
applauded
the
decision,
stating
that
it
protects
healthcare
for
millions
of
Americans.
“The
Trump-Vance
administration
is
making
life
harder
for
working
Americans,”
said
Skye
Perryman,
president
and
CEO
of
Democracy
Forward.
“It
should
be
doing
everything
possible
to
increase
access
to
affordable
health
care,
but
this
administration
seems
intent
on
making
accessing
basic
health
care
harder.
We
are
pleased
the
court
has
stepped
in,
and
we
will
continue
to
pursue
this
case
to
ensure
that
the
Affordable
Care
Act
fulfills
its
promise
of
affordable,
accessible
health
care
for
all.”
This
lawsuit
is
separate
from
a
similar
lawsuit
filed
by
a
group
of
Democratic
attorneys
general.
A
decision
has
not
been
made
on
that
lawsuit
yet.
The
judge’s
ruling
Specifically,
Hurson
issued
a
stay
on
seven
of
the
nine
provisions
challenged
by
the
plaintiffs.
This
means
that
these
provisions
cannot
go
into
effect
until
the
judge
issues
a
final
ruling,
or
if
Hurson’s
ruling
is
appealed
and
reversed.
He
noted
that
several
of
the
provisions
of
the
Marketplace
Integrity
and
Affordability
Rule
are
either
not
authorized
by
the
Affordable
Care
Act
and
are
contrary
to
law,
or
are
“arbitrary
and
capricious.”
The
latter
means
the
agency
didn’t
adequately
explain
its
rationale
for
these
provisions.
The
provisions
he
issued
a
stay
on
include:
-
The
requirement
for
Marketplaces
to
automatically
re-enroll
consumers
who
haven’t
updated
their
eligibility
information
into
plans
with
a
$5
monthly
premium
instead
of
fully
subsidized
coverage -
The
provision
allowing
insurers
to
demand
payment
of
past-due
premiums
before
issuing
new
coverage -
The
rule
cutting
off
premium
subsidies
for
people
who
didn’t
reconcile
past
tax
credits -
The
provision
requiring
additional
documentation
to
verify
eligibility
for
special
enrollment
periods -
Two
income
verification
requirements
requesting
additional
documentation
for
applicants
with
very
low
income
or
no
tax
records
to
confirm
their
reported
income -
The
provision
giving
insurers
more
flexibility
in
how
generous
their
health
plans
are
by
loosening
the
rules
around
actuarial
value,
or
the
percentage
of
costs
a
plan
covers
“The
Court
finds
that
Plaintiffs
have
met
their
burden
of
showing
that
there
is
a
strong
likelihood
that
they
will
succeed
on
the
merits
of
their
challenges
to
seven
provisions
of
the
Rule.
…
Plaintiffs
have
also
shown
they
will
face
irreparable
harm
if
the
challenged
portions
of
the
Rule
are
not
enjoined,”
the
judge
wrote.
“Finally,
the
balance
of
equities
and
the
public
interest
weigh
in
favor
of
a
stay.”
The
judge
did
not
issue
a
stay
for
two
other
provisions,
which
will
go
into
effect.
These
include
CMS’s
changes
to
the
premium
adjustment
percentage
methodology
and
its
decision
to
revoke
the
60-day
extension
for
resolving
data
matching
issues.
There
are
also
some
provisions
that
weren’t
challenged
by
the
plaintiffs,
such
as
the
exclusion
of
Deferred
Action
for
Childhood
Arrivals
(DACA)
recipients
from
Marketplace
coverage.
The
DACA
program
protects
young
adults
without
U.S.
citizenship
or
legal
status
from
deportation.
These
young
adults
were
minors
who
accompanied
their
parents
or
other
family
members
when
the
latter
illegally
crossed
the
border.
While
they
had
certain
protections
under
Democratic
administrations,
Republicans
under
the
Trump
administration
have
sought
to
remove
those
protections.
What’s
ahead?
The
Trump
administration
has
appealed
the
district
court’s
decision
to
the
Fourth
Circuit
Court
of
Appeals.
However,
it’s
unlikely
that
the
appeals
court
will
make
a
decision
ahead
of
the
open
enrollment
period,
which
starts
on
November
1.
“These
can’t
move
forward
until
there’s
either
some
resolution
of
an
appeal
or
this
federal
trial
board
makes
a
final
decision
on
the
issue,”
said
Kaye
Pestaina,
director
of
KFF’s
Program
on
Patient
and
Consumer
Protection,
in
an
interview.
“So
there
is
a
chance
that
these
might
not
be
implemented
when
they
were
supposed
to
be
effective,
but
we’ll
see
how
fast
the
courts
move
and
what
happens
next.”
At
least
one
patient
advocacy
organization
hopes
that
the
delayed
provisions
are
permanently
blocked.
“The
rule
is
another
one
of
the
Trump
administration’s
unlawful
and
harmful
attacks
on
health
care
that
creates
significant
hurdles
for
families
and
individuals
–
mainly
immigrant
and
marginalized
communities
–
to
access
health
insurance
through
the
Affordable
Care
Act,”
said
Sophia
Tripoli,
senior
director
of
health
policy
at
Families
USA.
“It
significantly
undermines
the
ACA’s
intended
purpose
and
reverses
the
record
health
coverage
gains
made
over
the
past
few
years.”
If
the
complete
rule
does
go
into
effect,
it
could
cause
significant
harm,
especially
when
combined
with
changes
in
the
One
Big
Beautiful
Bill
Act
and
the
expiration
of
the
ACA
enhanced
premium
tax
credits
at
the
end
of
this
year.
That
said,
it’s
possible
Congress
may
issue
an
extension
to
the
tax
credits.
“All
these
factors
are
working
together
to
drive
premiums
higher
next
year
and
to
drive
enrollment
lower,”
said
Louise
Norris,
health
policy
analyst
with
healthinsurance.org.
“But
some
of
it
is
still
up
in
the
air,
like
this
marketplace
rule
where
all
these
provisions
have
been
stayed.
We
don’t
know
when
the
court
ruling
will
eventually
come,
and
we
don’t
know
what
it
will
say,
and
then,
obviously,
we
don’t
know
what
Congress
will
do
as
far
as
extending
the
subsidy
enhancement.”
While
the
future
remains
uncertain
for
those
enrolled
through
the
ACA
Marketplaces,
it’s
clear
that
this
year’s
open
enrollment
period
is
likely
to
be
marked
by
significant
confusion.
The
Democrats
may
have
notched
a
victory
with
the
judge’s
ruling
but
it
may
only
be
a
temporary
win.
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kroach,
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