I've repeatedly written about how Donald Trump is still deperately trying to sabotage the ACA by any means necessary. Last year it was all about a combination of regulatory and legislative attacks, but aside from repealing the ACA's individual mandate (which was, admittedly, a pretty ugly blow), the GOP-held Congress was unsuccessful at tearing it down legislatively.
Therefore, for 2018, Trump has decided to double down on the regulatory side...and one of the main ways he hopes to achieve this is by opening up the floodgates on so-called "Short-Term, Limited Duration" policies, which aren't subject to most ACA requirements and therefore are a) free to siphon off healthy ACA-compliant enrollees into b) substandard healthcare plans which can leave thousands of people in dire straits.
Over at the Kaiser Family Foundation, Karen Pollitz and Gary Claxton have published a handy explainer which goes over the basics of the various types of NON-ACA individual market policies...specifically, the "Short Term" and "Association" plans which Donald Trump is attempting to flood the market with by essentially removing any restrictions or regulations on them, but also the "Idaho Style" plans which were rejected by HHS for being flat-out illegal as well as the "Farm Bureau" junk plans which Iowa recently decided to open the floodgates on (Tennessee already had a similar setup, and sure enough, it has proven pretty devastating to Tennessee's ACA market since 2014 as a result). The whole thing is worth a read, but in the early part of their explainer, however, they also happened to neatly lend support to my estimates from last week regarding the unsubsidized market:
I've obviously already written a bunch of stuff about this, including links to a few impact projection analyses, but this one was put together by Avalere Health on behalf of America's Health Insurance Plans (AHIP), which is one of the two major insurance carrier lobbying groups (the other one is BCBSA). On the surface you may expect a whitewash: "Oh, look at that, a report commissioned by Big Insurance is releasing a report claiming that these policies would be awesomesauce, big surprise!"
For some time now, I've been railing against Donald Trump's executive order pushing for the expansion of both "Short Term, Limited Duration" plans as well as "Association Plans". I've scornfully referred to his EO with the hashtag #ShortAssPlans.
Something which has gotten lost in the shuffle, however, is that I don't think short-term plans should necessarily be scrapped altogether, at least until we're able to achieve a comprehensive, universal coverage system in the future. Under our current patchwork heatlhcare system, I do think they serve a purpose for certain people in certain circumstances. I just think they need to be strongly regulated and limited in scope, partly to prevent siphoning off healthy people from the individual market risk pool...but partly to prevent people from being hit with financial catastrophe in the event of unexpected high medical expenses.
The problem is that Trump's executive order--which would effectively open the floodgates for them to be mutated into year-round plans, completely destroying one of the major points of the ACA in the first place.
To be honest, I'm not entirely sure I understand why Idaho would do this. Yes, of course the deep red state government opposes the ACA in general and sure, they want to "lower premiums" on the individual market, but Trump's recent "ShortAss Plan" executive order would do pretty much the same thing(allowing non-ACA compliant off-exchange "Short Term/Association Plans" which amount to the same thing...without putting GOP Gov. Butch Otter's fingerprints all over the ugly stories which would soon follow if/when people started actually enrolling in these types of policies. Besides, as much as Idaho claims to hate the ACA, they seem to be quite proud (and rightly so) of their own state-based ACA exchange, Your Health Idaho.
Well, it sounds like CMS Administrator Seema Verma was thinking along the same lines, because this unexpected story broke a few hours ago: Verma sent a letter to Otter and his state Insurance Commissioner shooting down their "state-based plans" idea as being flat-out illegal.
*(except people who are actually sick, that is) --h/t Anne Paulson
I've written a lot about Idaho's decision to simply ignore ACA regulations by allowing non-ACA compliant healthcare policies which would destabilize the individual healthcare market even worse than it already is today.
But it would be a mistake to ignore what Idaho is up to. If the Trump administration doesn’t intervene, other red states will surely follow in its footsteps. The result will be widespread disregard of the law and the rise of state-to-state inequalities in the private market similar to those that already exist in Medicaid.
Kreidler announces intention to being rulemaking on short-term medical plans
March 6, 2018
OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced his intention today to begin rule-making to create protections for Washington consumers who buy short-term medical plans. He is taking this action in response to the recent rules the Trump administration proposed to increase the duration of short-term medical plans from 90 days to up to 364 days.
In a statement last week, Kreidler shared his concerns about short-term medical plans:
U.S. SENATOR TAMMY BALDWIN AIMS TO BLOCK PRESIDENT TRUMP’S PLAN TO ALLOW INSURERS TO SELL JUNK PLANS WITH LEGISLATION TO GUARANTEE PROTECTIONS FOR PRE-EXISTING CONDITIONS
“The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”
WASHINGTON, D.C. – Following the Trump Administration’s recent proposed rule allowing insurance companies to once again sell ‘junk’ health care plans, U.S. Senator Tammy Baldwin today announced new legislation to block the rule and guarantee protections for people with pre-existing conditions.
In 2018, unsubsidized premiums for ACA-compliant individual healthcare policies have shot up by around 30% on average nationally. Around 18 points of this (60% of the total) is due specifically to policy decisions by the Trump Administration and Congressional Republicans, primarily the cut-off of Cost Sharing Reduction reimbursement payments and the (accurate, as it would later develop) anticipation, by some carriers, of the ACA's individual mandate being repealed.
What about 2019, however? The 2-3 points tacked on out of concern for the mandate being repealed was only a small portion of the full impact insurance carriers expect it to have, and of course there's the further undermining of the ACA via Donald Trump's "Short Term" and "Association Plan" executive orders. Finally, there's the impact of what is assumed to be another year of the advertising/outreach budget being starved by the Centers for Medicare & Medicaid.