Cost-Sharing Reductions, Technocrat Tinkering, and Market-Based Health Policy.

MEDICAL care cost shifting; TECHNOCRACY; HEALTH policy; PATIENT Protection & Affordable Care Act; HEALTH insurance exchanges; MEDICAL care laws; ECONOMIC impact of health care reform; MEDICAL care costs; HEALTH insurance & economics; FEDERAL government; HEALTH care reform; INSURANCE; GOVERNMENT aid; ECONOMICS

The Trump Administration has exposed both the durability and vulnerability of the Patient Protection and Affordable Care Act's insurance reforms. One of the Administration's first strikes at "Obamacare" was to discontinue federal government payment of cost-sharing reductions, which insurers pay to low-income enrollees on the exchanges to reduce their out-of-pocket share of medical spending. The states struck back with a clever solution that could hold insurers and enrollees harmless. This article examines this strategy and why, while impressive, it reaffirms larger problems with the ACA's market-based approach to health reform and the need for new pathways forward. [ABSTRACT FROM AUTHOR]