The Trump administration is running out of time to deliver on the cornerstone of its health coverage agenda--the repeal of the Affordable Care Act (ACA) and its replacement with a "beautiful plan." The executive order issued in September 2020 is a largely symbolic document rather than a comprehensive replacement plan, although it also simply restates three bite-sized initiatives that were first set out in a January 2017 executive order and which haven't made much headway in New York. The first initiative, loosening rules on association health plans, was challenged in the courts by a coalition of state attorneys general led by New York, with a decision still pending. A second regulation authorizing "bare-bones" short-term limited-duration insurance policies that lack ACA consumer protections was blocked by New York's insurance regulator. The third of these initiatives, individual coverage health reimbursement arrangements (ICHRAs, pronounced "ick-ruhs"), authorizes employers to subsidize individual coverage workers buy on their own. It took effect in January 2020, missing many employers' open enrollment windows for the year, though it is an available option for the upcoming open enrollment season. While the ICHRA proposal may be the best of a bad lot in terms of the Trump administration's coverage initiatives, this brief examines the rule's significant risks for New York consumers, particularly lower-income enrollees.
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