United States health officials seek to expand short-term health coverage

Trump's new plan to poke holes in the Obamacare markets, explained

HHS To Allow The Sale Of Short-Term Health Plans, Further Gutting O'Care Market

According to Fox News, the Trump administration pushed the revised guidelines to the nation's largest insurance providers Tuesday, hoping "alternative plans" would help lower premiums and drive down costs in the highly regulated marketplace.

Short-term plans would not need to cover the essential benefits mandated by the ACA such as maternity care, care for those with pre-existing conditions, mental health treatment, prescription drugs or even preventative care.

Short-term health plans, which have been available for years and were originally created to fill a temporary gap in coverage, are likely to be cheaper than Obamacare policies. The plans don't have to cover people with pre-existing conditions, for example, and insurers can charge higher premiums based on a consumer's health status.

"People who buy short-term policies today in order to reduce their monthly premiums take a risk that, if they do need medical care, they could be left with uncovered bills and/or find themselves uninsurable under such plans in the future", wrote Karen Pollitz, senior fellow at the Kaiser Family Foundation, in a recent policy brief. Middle-class enrollees could be hit especially hard since they are don't receive the same level of subsidies as lower-income beneficiaries.

"In 2008, one of the important policy motivators for what ultimately became the ACA was protecting people from so-called mini-med plans that provided coverage in name only", says Rodney Whitlock, a health care consultant with ML Strategies who worked as a Republican staffer on the Senate Finance Committee when the Affordable Care Act was written.

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However, the proposed rule states that the shift of members to short-term plans in 2019 would cause average monthly individual premiums to increase along with the average monthly premium tax credit available to exchange members with incomes up to 400% of the federal poverty level.

The proposal comes from the departments of Health and Human Services, Labor and Treasury in response to an executive order Trump issued in October. "These sham plans are likely to cause the price of comprehensive coverage to escalate if healthier individuals and families exit the marketplace where comprehensive coverage is sold and instead buy these junk policies". Insurance companies would be required to prominently display in the contract and application materials that the policy is exempt from requiring some ACA protections.

On a call with reporters on Tuesday, CMS Administrator Seema Verma spent several minutes painting the Affordable Care Act as a disaster, pointing to rising insurance premiums, the many states and counties that have only one insurer, and the 28 million people who remain uninsured-though all of these problems existed prior to the ACA. It is seeking input on whether these plans should be available for more than 12 months and on which options consumer should have if they want to renew their coverage.

Larry Levitt worries an exodus from the ACA market will hurt the people who need insurance the most.

HHS is also exploring allowing the plans to be renewed after a year. That wouldn't be a problem next year, when repeal of the ACA requirement that most Americans have coverage takes effect.

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That could leave behind an older, sicker, and costlier market. In most states, premiums have increased between 2017 and 2018, though tax credits (a type of subsidy) have increased in nearly every state, according to the Kaiser Family Foundation. The federal government will pick up the tab for these people, and this will cost taxpayers $96 to $168 million more every year - a figure based on a conservative estimate of the number of people who will flee.

Asked specifically about a different but related matter, whether he would intervene in Idaho where one insurer has filed plans that openly defy the ACA and some say break the law, Azar said he was not in a position to rule on the issue.

Also, short-term plans don't have to offer comprehensive coverage.

The ACA has proven remarkably resilient in the face of the Trump administration's efforts to undermine it. Enrollment in marketplace plans held almost steady at 12 million people, even as HHS dramatically cut its spending on advertising and outreach. Since passage of the ACA, the number of bankruptcies has been cut in half.

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