Short-Term and Association Health Plan Rules Sell Patients Short


The Trump administration is set to implement two regulatory policies over the next several months that stand to create significant disruption in the individual health insurance market. The U.S. Department of Health and Human Services (HHS) recently published a final rule on short-term, limited duration insurance plans while the U.S. Department of Labor (DOL) recently published a final rule expanding the availability of Association Health Plans (AHPs).

HHS on August 3rd published its final rule implementing changes to short-term, limited duration insurance plans (ANA voiced its opposition to this proposed rule in April). These plans were initially intended as a stopgap in the event that an individual temporarily lost health insurance coverage. This final rule allows these plans to last for up to 12 months, up from three months under previous regulations, and allows them to be renewed for up to 36 months. These plans are not subject to the Essential Health Benefits (EHBs) requirements under the Affordable Care Act (ACA). The short-term, limited duration insurance final rule will take effect on October 3rd, 2018.

DOL on June 21st published its final rule implementing changes to AHPs (ANA voiced its opposition to this proposed rule in March). AHPs have been around for decades and are considered employer-sponsored insurance plans, and are thus not subject to certain ACA requirements for individual health insurance coverage, including the coverage of EHBs. The DOL final rule expands the definition of “employer” under regulations governing AHPs, and thus expands the types of employers and associations that can form AHPs. The AHPs final rule will take effect on August 20th, 2018.

Both final rules expand the availability of individual health insurance coverage that is not subject to the EHBs requirements under the ACA. These rules will facilitate the proliferation of insurance coverage that does not cover EHBs; the Congressional Budget Office estimates that six million more Americans will be covered by such insurance plans by 2023. This will make it more difficult for older individuals and those with pre-existing conditions to purchase individual health insurance coverage while driving up prices in the federal and state health insurance exchanges and threatening to fracture the national healthcare system framework established under the ACA.

States are already pushing back against these rules. New York and Massachusetts have sued the Trump administration over the expansion of AHPs, which they claim will “invite fraud, mismanagement, and deception.” And states have the power to regulate short-term, limited duration plans, some of which, including Maryland and Vermont, have already done so. States including Pennsylvania and Virginia have also expressed deep concerns over these as well as the fact that insurance brokers often use deceptive marketing tactics to promote them.

ANA strongly supports innovation and creative approaches to ensuring comprehensive, affordable healthcare coverage for all Americans. These proposals, however, have the opposite effect by driving up premium prices, pushing individuals in at-risk populations out of the insurance market, and widening population health disparities. Healthcare stands to be a major issue in the 2018 midterm elections – 22 percent of respondents to a June 2018 NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. ANA urges its members and anyone concerned about nursing issues to support candidates who uphold our core values and principles for health system transformation. It is vital that nurses’ voices as the nation’s most honest and ethical profession are heard in the public sphere, and that nurses make their influence known.

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