Consumers who searched online for health insurance during the Affordable Care Act's (ACA) latest open enrollment period frequently were directed to websites promoting short-term health plans and other types of non-ACA compliant plans, with little information about the plans' limitations, according to a study from the Georgetown University Health Policy Institute published Thursday.
The Trump administration in 2018 issued final rules that expanded U.S. consumers' access to non-ACA compliant health plans. The final rules expanded access to short-term health plans and association health plans, which are not required to comply with certain ACA requirements, including the ACA's minimum coverage requirements.
For the study, researchers examined the online marketing of short-term health plans and other types of health insurance in eight states—Colorado, Florida, Idaho, Maine, Minnesota, Missouri, Texas, and Virginia—which they chose to reflect diverse geography and regulatory approaches.
The researchers reviewed online advertisements before and during the ACA's latest open enrollment period. The researchers entered terms such as "ACA enroll," "cheap health insurance," and "Obamacare plans" into search engines and reviewed the first four results. The researchers analyzed a total of 256 search results and 65 websites.
The researchers also created a fictional consumer profile of a 29-year-old woman in good health with a $20,000 annual income, which would make her eligible for premium subsidies under the ACA, seeking health insurance. The researchers entered the consumer's information into lead-generating websites and answered six phone pitches from brokers selling non-ACA compliant health plans.
The researchers also interviewed regulators from each of the eight states.
The researchers found less than 1% of searches using common search terms generated results offering only ACA-complaint health plans before the open enrollment period began, and 19% of searches using common search terms generated results offering only ACA-complaint health plans during the open enrollment period.
The researchers found lead-generating websites promoting short-term health plans or other non-ACA compliant health plans represented more than 50% of all search results in the eight states before and during the open enrollment period. The lead-generating websites do not directly sell health plans to consumers, but they ask consumers for contact and demographic information, which can be sold directly to insurers and brokers or used to contact consumers and direct them to insurers and brokers.
The researchers found the six brokers who encouraged them to buy health coverage over the phone did not provide detailed information on the health plans they were selling, and most of them refused to provide written materials or ended calls when asked for materials.
The researchers also found state regulators did not have comprehensive information regarding which insurers marketed short-term health plans. One state regulator said it is "one of our biggest blind spots." Most of the state regulators said they plan to begin closely monitoring insurers' marketing practices in 2019.
Sabrina Corlette, the study's lead author and a research professor at the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute, said the findings offer early evidence that insurers are beginning to aggressively market short-term health plans as an alternative to exchange plans, and they are doing so without notifying consumers of the differences in benefits.
Corlette said, "It was disturbing, but not unexpected, to find such a high proportion of misleading ads and come-ons. That raises the risk that consumers could be duped into buying health insurance that they think offers comprehensive and secure coverage, but does not." She said insurers' failure to adequately inform consumers about their coverage benefits could warrant federal and state oversight.
Michael Conway, Colorado's interim insurance commissioner, said he is concerned about the marketing tactics the study uncovered. Conway said the marketing strategies could have led unsuspecting consumers to choose health plans that did not meet their specific needs. He said, "We are on alert for complaints. If we have to strengthen our regulations on marketing, we will."
Eric Cioppa, Maine's insurance superintendent, told KHN his office does not have evidence consumers unknowingly bought short-term health plans because of misleading online marketing. Cioppa said, "We'll respond accordingly and aggressively if we find that took place" (Findlay, Kaiser Health News, 1/31; Baker, "Vitals," Axios, 2/1).
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