After a dramatic defeat in the Senate to repeal and replace the Affordable Care Act (ACA), the Trump administration has sent conflicting signals on how it will handle administration of the law, even as some in the administration tout new programs aimed at strengthening insurance markets and bringing down premiums. After the repeal failed, news reports said that the president might withhold cost-sharing subsidy payments that keep premiums down for those insured through ACA marketplace plans. About 58% of all marketplace consumers rely on the cost-sharing subsidies, according to the Commonwealth Fund. The administration has already suspended $22 million worth of contracts to promote enrollment in marketplace plans.

Meanwhile, leaders of the Senate Committee on Health, Education, Labor and Pensions plan hearings in September on continuing the $7 billion subsidy payments, with a possible glide path to decrease them
over time.

Yet the subsidy payments were made in August, and Health and Human Services secretary Tom Price, as well as Centers for Medicare and Medicaid Services Administrator Seema Verma have been laying out plans to spur innovation through policy available under the ACA.

For example, in March, Price and Verma wrote to governors encouraging them to apply for state innovation waivers under the ACA. These waivers allow states to experiment with new, innovative policies and make their own rules about covered benefits, insurance marketplaces, and subsidies. So far many governors have been receptive to the waivers.

For insurers, time is running out to make 2018 plans. Up to 10 insurers, including Aetna, Humana, and UnitedHealthcare, already plan to pull out of the marketplace in at least one state. In an August 10 statement about its intent to drop 2018 insurance plans in Nevada, Anthem called the individual insurance market “volatile” and said that “planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations.”