Judge blocks Trump's small-business health insurance plan

特朗普小企业医疗保险计划遭否决,一周面临医改两连败

2019-04-02 07:35:00 Marketbeat

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A federal judge has struck down a small-business health insurance plan widely touted by President Donald Trump, the second setback in a week for the administration's health care initiatives. U.S. District Judge John D. Bates wrote in his opinion late Thursday that so-called "association health plans" were "clearly an end-run" around consumer protections required by the Obama-era Affordable Care Act. On Wednesday, another federal judge blocked the Trump administration's Medicaid work requirements for low-income people. The legal setbacks came as Trump unexpectedly pivoted back to health care this week, promising a new plan to replace the ACA, commonly called "Obamacare." But many congressional Republicans don't want to have that fight again. Democrats are gleeful, seeing a chance to shift the national conversation to one of their top issues. Justice Department spokeswoman Kelly Laco said in a statement Friday the Trump administration disagrees with the judge's ruling on association health plans and is "considering all available options," including an appeal. The plans at issue in Bates' ruling Thursday allow groups of small businesses and sole proprietors to band together to offer lower-cost coverage that doesn't have to include all the benefits required by "Obamacare." The plans also can be offered across state lines, an attempt to deliver on a major Trump campaign promise. But Bates wrote that key parts of the Trump administration's policy are "unlawful and must be set aside" because they go against established definitions of what constitutes an employer under a decades-old federal law that governs workplace health and pension benefits. In particular, a decision by the administration that sole proprietors can be counted both as employers and employees "stretches the statute too far," Bates wrote. Trump has eagerly talked up the plans , claiming they're doing record business and promising small business owners "you're going to save massive amounts of money and have much better health care." But the plans don't seem to have had a major impact. The Labor Department regulation authorizing them only took effect last summer. "There's been a few of these that have been announced," said Gary Claxton, an expert on employer health insurance with the nonpartisan Kaiser Family Foundation. "It hasn't been in effect all that long." Claxton estimated that only a few thousand people may be covered by association plans at the moment. Initial estimates said 3 million to 4 million people eventually would enroll, compared with more than 160 million Americans covered by current employer plans. New York Attorney General Letitia James, who joined other Democratic state officials in suing the Trump administration, said the judge "saw past the Trump administration's transparent effort to sabotage our health care system and gut these critical consumer protections in the service of its own partisan agenda." Many state officials see federal insurance regulation of small-business plans as infringing on their own traditional authority. The Trump administration, unable to repeal "Obamacare" in Congress, has tried to use its rule-making powers to open up a pathway for alternatives. In the case of plans for small businesses and sole proprietors, the administration's regulation granted them similar flexibility as enjoyed by big companies. Most large employer plans are not subject to state regulations, and the Obama health law did not make major changes to them either. But Bates wrote that treating sole proprietors similar to major employers "creates absurd results." For example, said the judge, consider a hypothetical association of 51 sole business owners with no employees. Under the administration's rule, they would in effect be counted as having 51 employees. Not only that, each of the 51 working owners would also be counted as an "employer" although they have "zero" people working for them, the judge wrote. And the association also would count as an employer, for a total of 52 employers. Bates was nominated to the federal bench by then-President George W. Bush, a Republican. His ruling could signal limits to how far the Trump administration can advance with its strategy of relying on regulations to transform health care. Trump is undeterred. The president jumped back into the health care debate this week, with the administration joining the side of Texas and other GOP-led states seeking to completely overturn "Obamacare" as unconstitutional. He's also promising a new health care plan that would be much better than "Obamacare," tweeting that Republicans will become "the Party of Great HealthCare!" But there's no indication that the White House, executive branch agencies like Health and Human Services or Republicans in Congress are working on a comprehensive plan. Many congressional Republicans see the Texas lawsuit as a political land mine. If "Obamacare" is overturned Republicans would be on the hook in the 2020 election year to come up with an alternative. The GOP turmoil over health care has come as a boon to Democrats, who are looking to change the subject from special counsel Robert Mueller's conclusion that the Trump campaign did not conspire with the Russian government to sway the 2016 election. House Speaker Nancy Pelosi this week joined in unveiling legislation that would shore up and expand "Obamacare," allowing many more middle-class households to qualify for assistance paying their premiums.
一名联邦法官否决了一项小企业医疗保险计划,该计划受到唐纳德·特朗普总统的广泛宣传,这是特朗普政府在一周内实施的医疗保健计划的第二次挫折。 美国地方法官贝茨( John D . Bates )周四晚些时候在他的意见中写道,所谓的“协会健康计划”显然是奥巴马时代《平价医疗法案》( Affordable Care Act )所要求的消费者保护措施的“最终结果”。 周三,另一名联邦法官阻止了特朗普政府对低收入人群的医疗补助工作要求。法律上的挫折发生在特朗普本周出人意料地重新投票支持医疗保健,承诺推出一项新的计划来取代通常被称为“奥巴马医改”的 ACA 。但许多国会共和党人不想再进行这场斗争。民主党人很高兴看到有机会将全国对话转移到他们最重要的问题之一。 美国司法部发言人凯利·拉科星期五在一份声明中说,特朗普政府不同意法官对协会健康计划的裁决,并正在“考虑所有可能的选择”,包括上诉。 贝茨星期四的裁决中提出的计划允许小企业和个人独资企业联合起来提供低成本保险,而不需要包括“奥巴马医改”所要求的所有福利。这些计划还可以在州范围内提供,以实现特朗普竞选承诺。 但贝茨写道,特朗普政府政策的关键部分是“非法的,必须搁置”,因为它们违背了几十年来联邦法律对雇主构成的定义,该法律管辖工作场所健康和养老金福利。 贝茨写道,特别是政府的一项决定,即独资企业既可以被视为雇主,也可以被视为雇员,这“使法规过于冗长”。 特朗普急切地谈到了这些计划,声称他们正在做创记录的生意,并向小企业主承诺“你将节省大量资金,并拥有更好的医疗保健。”但这些计划似乎没有产生重大影响。去年夏天,美国劳工部颁布的授权法案才生效。 “其中有一些已经被宣布了,” GaryClaxton 说,他是非盈利组织 KaiserFamilyFoundation 的雇主健康保险专家。“这么久还没开始生效。” Claxton 估计目前只有几千人可以参加协会计划。初步估计,最终将有300万至400万人报名,而目前的雇主计划覆盖的美国人超过了1.6亿。 纽约州总检察长莱蒂亚·詹姆斯( Letitia James )与其他民主党州官员一起起诉特朗普政府。他表示,法官“看到特朗普政府以透明的方式破坏我们的医疗体系,并为自己的党派议程而破坏这些关键的消费者保护。” 许多州政府官员认为联邦保险监管的小企业计划侵犯了他们自己的传统权威。 特朗普政府未能在国会废除“奥巴马医改”,而是试图利用其制定规则的权力为替代方案开辟道路。对于小企业和独资企业的计划,政府的规定给予它们与大公司一样的灵活性。大多数大型雇主计划都不受州法规的约束,特朗普的健康法案也没有对其做出重大改变。 但贝茨写道,对待与大雇主类似的独资企业“产生了荒谬的结果”。例如,法官说,假设51个独资企业所有者没有雇员。根据政府的规定,他们实际上将被视为拥有51名员工。这位法官写道,不仅如此,51位雇主中的每一位都将被视为“雇主”,尽管他们有“零”员工为他们工作。该协会还将被视为一个雇主,总共52个雇主。 贝茨被当时的共和党总统乔治·布什提名为联邦法官。他的裁决可能表明,特朗普政府依靠监管改革医疗保健的战略能够推进多大程度的限制。 特朗普毫不畏惧。特朗普本周再次参加了医疗保健辩论,政府加入了德克萨斯州和其他共和党领导的州的行列,试图完全推翻“奥巴马医改”的违宪。他还承诺一个新的医疗保健计划将比奥巴马医改好得多,他在推特上说共和党将成为“伟大的医疗保健党”。 但没有迹象表明,白宫、卫生与公共服务等行政部门或国会中的共和党人正在制定一项全面计划。许多国会共和党人认为德克萨斯的诉讼是一个政治矿山。如果“奥巴马医改”被推翻,共和党人将在2020年的大选中寻找另一种选择。 共和党在医疗保健问题上的动荡,对民主党人来说是个福音。民主党人正试图改变这个话题,从特别顾问罗伯特•穆勒( Robert Mueller )得出的结论来看,特朗普竞选团队没有与俄罗斯政府合谋影响2016年大选。众议院议长南希·佩洛西( Nancy Pelosi )本周也宣布了支持并扩大“奥巴马医改”( Obamacare )的立法,允许更多的中产阶级家庭有资格获得支付保费的援助。

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