Though congressional Republicans have repeatedly failed to repeal the Affordable Care Act, the Trump administration continues to cut support for the law's programs.
The Washington Post reports that President Donald Trump personally intervened when Iowa officials requested a section 1332 waiver, which was intended to help stabilize the state's individual market. Premiums in Iowa's are expected to rise (PDF) by 57% on average for 2018.
Trump saw a news article about Iowa's waiver request, according to The Post, then personally contacted officials at the Department of Health and Human Services to say the waiver should be denied.
The Trump administration has also slashed funding for open enrollment outreach by 90%, and a number of groups have said the HHS is not working with them on marketing for open enrollment as it had in previous years.
The open enrollment period was also cut down by almost two-thirds; it will be held this year from Nov. 1 to Dec. 15, a window of 45 days instead of three months. The administration also announced that it plans to shut down Healthcare.gov for 12 hours on all but one Sunday during open enrollment.
“It feels like someone has slammed on the brakes and we’re all lurching forward,” said Amanda Hooper, the director of engagement and mobilization with the National Women’s Law Center.
Iowa isn't the only red state impacted by the administration's ACA-related decisions. Oklahoma recently withdrew its request for a 1332 waiver because the Trump administration failed to approve it in a timely manner.
However, the administration approved a section 1332 waiver for Minnesota, according to a letter (PDF) from Centers for Medicare & Medicaid Services Administrator Seema Verma sent in late September. Verma said the federal government would provide $323 million to establish a reinsurance program under the waiver, as lower premiums would mean savings for the government.
However, Verma said the government would cut $369 million in funding for a different state program for residents who earn between 138% and 200% of the federal poverty level but don't qualify for the other subsidies.
Trump administration erodes contraceptive mandate
The White House is also taking aim at the ACA's contraceptive mandate, according to a pair of rules issued Friday. The rules are similar to drafts made public in May.
The first (PDF), issued jointly by HHS, the Internal Revenue Service and the Department of Labor, would allow employers to claim religious objections to providing birth control to employees. The second rule (PDF) offers the same exemptions on moral objections.
"The United States has a long history of providing conscience protections in the regulation of healthcare for entities and individuals with objections based on religious beliefs or moral convictions," federal officials wrote in the rules.
The measures would go into effect immediately, and the move has drawn ire from women's health groups.
“Reducing access to contraceptive coverage threatens to reverse the tremendous progress our nation has made in recent years in lowering the unintended pregnancy rate," Haywood L. Brown, M.D., president of the American Congress of Obstetricians and Gynecologists, said in a statement. "Instead of fulfilling its mission ‘to enhance and protect the health and well-being of all Americans,’ HHS leaders under the current administration are focused on turning back the clock on women’s health."
Editor's note: This article has been updated to clarify that President Trump reportedly told HHS to deny Iowa's waiver. The waiver's actual status had not yet been decided.