The Trump Administration’s FY19 budget proposal was released last week and unsurprisingly includes significant health care threats. Most notably, the repeal and replacement of the Affordable Care Act and Medicaid block grants – similar to (but with a lower inflation index than) the Graham-Cassidy proposal from last fall. Additional Medicaid proposals include asset tests, denying coverage to people who can’t prove immigration status and increased co-pays for inappropriate emergency room visits. This budget is unlikely to go anywhere but it does signal the current Administration’s priorities.

The Senate attempted to address the Deferred Action for Childhood Arrivals (DACA) program and other immigration reforms but failed to secure enough votes, leaving Dreamers in the lurch. Congress may try again in March. The ongoing court battle provides some security as they apply to renew their status for two more years, but they risk deportation until their applications are processed and approved. The Supreme Court passed on the Administration’s request to weigh in, allowing the lower courts to continue their work.

Proposed rules were released this week allowing consumers to purchase short-term, limited duration health plans. The Obama Administration had limited short-term plans to no more than 90 days to fill gaps in coverage. Short-term plans do not provide comprehensive benefits or Affordable Care Act (ACA) consumer protections – making them cheaper than plans offered through the Exchange. The proposed rules will allow short-term plans to last just under 12 months, creating a huge threat to the health insurance market as healthy consumers may opt for shorter-term, cheaper coverage. But this coverage may not protect consumers when they do get sick. Washington State’s Insurance Commissioner Mike Kreidler said yesterday, “These plans could seriously harm unsuspecting consumers.” Comments are due April 23.