ISSUE #8: The Affordable Care Act (ACA)

The ACA is not dead, but may be mortally wounded, leaving states little time to prepare.

Though Congress failed to repeal the Affordable Care Act (ACA) in 2017, there were several successful efforts to weaken the health care law.  Congress and President Trump’s administration eliminated some subsidies, cut the insurance enrollment period in half, significantly reduced marketing efforts for the program, and provided a regulatory landscape that experts say will undermine the federal program. Most notably, the tax reform effort signed into law in December 2017 will repeal the individual mandate in 2019.

Analysts predict chaos in the insurance marketplace due to repeal of the individual mandate. With premiums expected to increase dramatically, some insurers could leave the marketplace altogether. States may have little time to prepare for and control the fallout from the repeal of the individual mandate. Some ACA supporters have called for states to implement their own state mandates or penalties, but while the mandate was a central part of the ACA it also remains one of its most politically unpopular features. Therefore, it is uncertain whether state leaders, especially in conservative states, will embrace this approach.