How health providers, consumers could be impacted by latest Trump administration move against ACA

While the Trump Administration's latest challenge to the ACA is expected to be tied up in the courts for years, it could still have some more immediate impacts on insurers, health providers and consumers.

On Thursday evening, the Trump administration submitted a legal filing saying it would not "defend the constitutionality" of key provisions of the Affordable Care Act in support of a lawsuit filed by Republican-led states filed a lawsuit earlier this year.

Attorney General Jeff Sessions took the position that provisions such as the individual mandate and protections for patients with pre-existing conditions should be invalidated starting in January 2019.

While not a surprising position, it does raise plenty of questions.

"For states, for insurers, for consumers who are looking at this, it's not time to hit the panic button just yet," said Sabrina Corlette, Research Professor at the Center on Health Insurance Reforms (CHIR) at Georgetown University's Health Policy Institute. She submitted an expert brief in support of an effort of Democratic attorneys general who intervened in the Republican lawsuit to defend the 2010 law.

Still, she said, there could be some immediate impacts that ripple through the system.

States that have passed Medicaid expansion will be concerned about the potential future loss of the federal match dollars. And as insurers work to predict their risk and set their rates by the end of this month for the upcoming enrollment period, they'll be working with another unknown.

"When insurers don't know what their risks are going to be, they are going to err on the side of being conservative," Corlette said. "We were already going to see premiums rise but this will make them rise even more."

In the February lawsuit filed by states, officials claimed when Congress eliminated the penalty for the individual mandate as part of a sweeping tax bill, that it rendered much of the Affordable Care Act unconstitutional.

In other words, without the individual mandate, the entire house of cards that made the ACA work just falls apart, said Leighton Ku, professor and director of the Center for Health Policy Research at George Washington University.

"It did hurt the law somewhat. But there would be very sweeping, harmful effects if the ACA is canceled," said Ku, pointing to the millions of people who benefited from the ACA's closure of the Medicare doughnut hole on prescription drug coverage, who were able to stay on their parents' plans until age 26 or who received tax credits or protections for their pre-existing conditions which allowed them to afford health coverage,

These challenges could wind up being appealed all the way up to the Supreme Court, a process that would take years, and are largely symbolic.

But other moves by the Trump administration have had a greater impact the ACA, such as the introduction of association health plans. "Those sorts of things are far more damaging because those were real," Ku said.

Still, health providers are watching this closely, said Ben Isgur, leader of the Health Research Institute at PricewaterhouseCoopers.

"Decisions like this, changes like this, often sow a lot a confusion into the consumer market," Isgur said. "Now a lot of people don't understand, 'Does this change anything yet?' Am I still covered?'" They may have questions about whether pre-existing conditions are still covered or become nervous about losing coverage. "Providers are going to have people coming into their system who have a lot of questions," he said.

Thinking long-term with the ongoing threats to the ACA, the health industry needs to work harder at helping a potential balloon of consumers who are uninsured or underinsured see and access lower cost options if they don't have the means, Isgur said.

"It will rest on shoulders of providers to help them navigate the system," he said.