• On October 6, the Trump administration announced an expanded religious exemption to the requirement that employers provide health insurance plans that include contraception services. The Affordable Care Act requires employers to provide preventive care coverage (including contraception) at no additional cost to their employees. Religious institutions, religiously affiliated nonprofit groups and closely-held private companies were exempt. The Trump administration’s expanded exemption applies to all for-profit companies, both privately-owned and publicly-traded.
  • On October 6, Attorney General Jeff Sessions announced a directive to all federal agencies to accommodate claims that religious freedoms are being violated. A claim of a violation of religious freedom would be enough to override concerns for the civil rights of LGBT people and anti-discrimination protections for women and others, without proof that discrimination was based on sincerely-held religious beliefs.
  • On October 12, Trump signed an executive order directing that federal rules affecting health insurance be revised. Trump’s order would allow associations of employers to buy health insurance across state lines and avoid some state and federal insurance requirements. It would allow short-term insurance plans to avoid federal and state rules requiring standard benefits and consumer protections. According to some experts, these rule changes could undermine the Affordable Care Act by allowing healthier people to buy lower-cost plans with limited benefits while increasing premium costs for people with health problems.
  • On October 12, Trump ordered a halt to reimbursements to insurers for cost-sharing reduction payments (CSRs) required under the Affordable Care Act. Under the ACA, insurers are required to offer health insurance plans with reduced deductibles and lower out-of-pocket expenses for people earning up to 250 percent of the federal poverty level—about 7 million people who buy health insurance on the individual market. Federal reimbursement is also required under the ACA, but there is a legal dispute about whether Congress has appropriated the funds. The case is pending before the U.S. Court of Appeals for the District of Columbia Circuit. Without reimbursement, insurers are expected to increase premiums. The Congressional Budget Office has estimated that eliminating the CSRs would increase taxpayer costs by $6 billion in 2018 and $21 billion in 2020 because federal tax credits for many Americans covered under the ACA will rise when their premiums increase.
  • The United States, Russia, China, Britain, France and Germany reached an accord with Iran in 2015 with the goal of preventing Iran from developing a nuclear weapon. An agreement was signed on July 14, 2015, that would limit Iran’s nuclear development in exchange for relief from economic sanctions. Meanwhile, Congress enacted the Iran Nuclear Agreement Review Act (INARA). The law gave Congress 60 days to review the details of the final agreement. During the review period after the final deal was reached, Congress was unable to pass any legislation approving or disapproving the Iran deal. In addition, INARA required the President, every 90 days, to certify that Iran is fully implementing the agreement and has not committed a material breach of the agreement, that Iran has not taken any action that could significantly advance its nuclear weapons program, and that suspension of sanctions against Iran is appropriate and proportionate to measures taken by Iran with respect to terminating its nuclear program and is vital to U.S. national security interests. Trump certified Iran’s compliance in April and again in July, but on October 13, he announced that he would not again certify compliance. Under INARA, Congress has 60 days to initiate expedited consideration of legislation reinstating statutory sanctions against Iran.

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