June 4, 2018

Industry groups have weighed in on Trump's big new health care rules—and 95% aren't fans

Daily Briefing

    Nearly all health care groups that commented on President Trump's proposals to expand the use of association and short-term health plans criticized the efforts.

    New: How the Medicare ACO models stack up

    About the proposals

    Association health plans

    The Department of Labor (DOL) in January released a proposed rule that aims to expand access to association health plans (AHPs) by broadening requirements under the Employee Retirement Income Security Act (ERISA), such as the types of employers that are eligible to form an AHP.

    Current regulations require AHP members to be in the same industry and to be involved in day-to-day decisions of a business. Further, associations sponsoring health plans currently must exist for a reason beyond providing health insurance. The proposed rule eases those requirements and instead would allow employers in different industries to form an AHP if they reside in the same geographic region.

    The proposed rule also would change the definition of an employer under ERISA to include self-employed individuals who work 30 hours per week or 120 hours per month and are considered "sole proprietors." In addition, under the proposed rule more AHPs would be considered large-group plans, which means they would be exempt from certain Affordable Care Act (ACA) regulations, such as the law's essential health benefit requirements.

    Short-term health plans

    In addition, HHS in February released a proposed rule that would again allow insurers to sell short-term health plans that are valid for up to 12 months.

    According to CMS, short-term health plans are "designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another form of coverage." The plans are not required to comply with certain ACA requirements, such as provisions that bar insurers from denying an individual coverage or charging him or her higher premiums based on pre-existing medical conditions. The plans also do not have to comply with the ACA's minimum coverage requirements.

    Prior to 2016, insurers were able to sell short-term plans that were valid for up to 364 days. HHS under former President Barack Obama shortened the use of such plans to just three months in an effort to curtail their use and encourage individuals to purchase ACA-compliant coverage, but HHS' proposed rule would allow insurers to sell short-term health plans that are valid for up to one year.

    LAT finds vast majority of health care groups oppose proposed changes

    The Los Angeles Times reviewed thousands of official comment letters regarding the proposed rules that were submitted to federal agencies. According to the Times, 266 of the 279 health care groups that commented on the Trump administration's AHP proposal expressed concerns about or opposition to the proposal, representing more than 95% of such groups.

    Meanwhile, 335 of the 340 health care groups that commented on the administration's short-term health plan proposal expressed concerns about or opposition to the proposal, representing more than 98% of such groups, according to the Times.

    Consumer and patient advocacy groups, nurse and physician organizations, and trade groups representing clinics, health insurers, and hospitals submitted comments on the proposals.

    No groups representing hospitals, nurses, patients, or physicians voiced support for the proposals in their comments, while comments from individual health care businesses—such as benefit consultants, insurers, and medical systems—offered more mixed reviews, the Times reports.

    According to the Times, insurance regulators from six states praised one or both of the proposals. But both Republican and Democratic insurance regulators in other states warned that the proposals could destabilize insurance markets, cause health plan premiums to rise for U.S. residents with medical conditions, and result in increased insurance fraud, the Times reports.

    Further, industry groups and other experts warned against scaling back consumer protections implemented under the ACA. For example, the American Academy of Pediatrics said the administration's proposal to expand AHPs ultimately "could leave children, particularly children with serious, chronic, or complex medical needs, with less comprehensive coverage and higher out-of-pocket costs."

    Separately, AARP said the AHP proposal would "greatly increase the likelihood that working Americans, especially those age 50-64, would face higher insurance premiums and loss of access to critical health insurance coverage."

    Meanwhile, Mental Health America in comments on the administration's short-term health plan proposal warned that such plans are "not a realistic option for people with chronic behavioral health concerns."

    The American Diabetes Association said the short-term health plan proposal ultimately would leave diabetes patients with "two undesirable options":

    • A costly plan that does not offer adequate benefits; or
    • A short-term health plan "with severely limited coverage and high out-of-pocket costs."

    Overall, Kris Haltmeyer, vice president of health policy and analysis at the Blue Cross Blue Shield Association, told the Times that the comments seem to show "a pretty overwhelming statement of concern."

    Similarly, Sandy Praeger, a former Republican state insurance regulator in Kansas and former president of the National Association of Insurance Commissioners, told the Times, "Basically anybody who knows anything about health care is opposed to these proposals."

    But some business groups said the proposals could increase U.S. residents' access to affordable health plans, the Times reports. For instance, Health Agents for America said although it believes short-term health plans "are not the best option for many Americans," they "could expand affordable access to health coverage for certain individuals" (Levey, Los Angeles Times, 5/30; Cutner, Live Insurance News, 6/1).

    New: How the Medicare ACO models stack up

    Hospitals, health systems, and physician groups across the country continue to evaluate the menu of Medicare ACO options. Whether applying for the first time, graduating to downside risk, or tracking CMS's evolving approach to ACOs, leaders need to understand the key details of each model.

    Download this infographic to learn how the different Medicare ACO models stack up.

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