Author: ANA Capitol Beat

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.

Trump Administration Intensifies Efforts to Erode Nation’s Access to Healthcare

  

The Trump administration has recently escalated its attacks on the health system under the Affordable Care Act (ACA) and continues to undermine the ability of Americans – particularly low-income women and individuals with pre-existing conditions – to access affordable and comprehensive healthcare coverage. These policy decisions – which come at the same time as a U.S. Supreme Court ruling with implications for access to reproductive healthcare services – are certain to erode the healthcare coverage gains made since 2010 and create significant harm, risk, and uncertainty for some of America’s most vulnerable populations.

The Centers for Medicare & Medicaid Services (CMS) on July 10 announced that it would further cut grants to nonprofit organizations that assist individuals in signing up for health insurance coverage on the ACA’s individual market. The federal government provided $63 million to such organizations in 2016, $36 million in 2017, and will provide only $10 million this year – a total reduction of roughly 84 percent. CMS, in another significant shift, will also encourage such organizations to enroll individuals in Association Health Plans (AHPs) as opposed to the more comprehensive ACA health plans. These plans – which the administration expanded last month and which ANA strongly opposes – offer coverage without essential health benefits guarantees and will disadvantage individuals with pre-existing conditions.

The administration argues that insurance companies and brokers are much better at enrolling individuals into insurance plans, and that AHPs offer a less expensive option for Americans struggling to pay for health insurance. However, despite major outreach efforts last year by outside groups – including ANA – to enroll individuals in ACA plans, enrollment dipped for the first time since the law was implemented. Meanwhile, the expansion of AHPs will result in higher premiums and fewer coverage options for Americans with pre-existing conditions, while individuals who purchase coverage through an AHP will have less comprehensive coverage than what is required of ACA health plans.

The administration on July 7 also announced that it would suspend billions of dollars in risk adjustment payments required by the ACA to be paid to insurance companies. These payments are intended to stabilize the individual market by preventing insurance companies from only seeking out healthy individuals and encouraging them to promote coverage for individuals with costly pre-existing conditions.

Suspending these payments creates uncertainty in the individual market, just as insurance companies are determining premiums for calendar year 2019, and could significantly increase premiums in the individual market. The administration’s moves to expand the use of AHPs and decrease the amount of funding available for outreach could be disastrous for individuals who purchase health coverage through the individual market and will likely lead to another year in which the number of Americans without health insurance coverages rises.

The administration, however, has not only taken aim at the ACA’s healthcare coverage regulations. In June, the administration issued a proposal to change regulations related to Title X funding, which provides grants for critical family planning services for millions of Americans, particularly low-income women. This proposed rule would prohibit a recipient of Title X funding from “performing, promoting, referring for, or supporting, abortion as a method of family planning, nor take any other affirmative action to assist a patient to secure such an abortion.” This represents a gag order on providers and denies patients full medical information. This was recently bolstered by the U.S. Supreme Court ruling in NIFLA v. Becerra, where the Court ruled that it is unconstitutional on First Amendment grounds for the state of California to require family planning facilities to post information about state-sponsored abortion services.

This is antithetical to the Code of Ethics for Nurses which states that the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. This proposed rule interferes with that relationship and violates basic ethics of the profession, while threatening the ability of millions of Americans to access basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and well-woman exams. The uninsured, women of color and low-income families will be disproportionately affected if the clinics and health centers in their communities can no longer offer the needed care and critical medical information.

ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. The recent moves by the Trump administration fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services. The midterm elections this November are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. We urge you to make nursing’s voice heard loud and clear by supporting candidates who align with ANA’s principles for health system transformation and who are proven to be advocates for nurses and their patients!

Trump Administration Again Takes Aim at Pre-Existing Conditions

  

Even as individual states take steps to expand health coverage, the Trump administration continues its misguided approach to restricting access to care. The U.S. Department of Justice (DOJ) on Thursday June 7th filed a brief in U.S. District Court in the case of Texas v. United States which indicates that the government will no longer defend the constitutionality of the Affordable Care Act’s (ACA) guaranteed issue and community rating provisions, which protect the ability of the estimated 52 million Americans with pre-existing conditions, such as diabetes and arthritis, to purchase health insurance coverage. These provisions require private health insurance providers to offer coverage to Americans with pre-existing conditions and prohibit them from charging higher premiums based on an individual’s pre-existing condition(s). They are also some of the most popular provisions of the health law, with 75 percent of Democrats and 63 percent of Republicans in support.

These crucial provisions have made it possible for some Americans with pre-existing conditions to purchase health insurance coverage for the first time and have contributed to the decline in the percentage of Americans who are uninsured. In the unlikely event that these provisions are ruled unconstitutional, insurers will once again be able to charge prohibitively expensive premiums to these individuals – or to simply deny them coverage outright. This move by the DOJ also injects a fresh dose of uncertainty into the individual health insurance market, further contributing to instability that the administration and its allies in Congress have created.

Even as the Trump administration attempts this major blow to the health law’s provisions on individuals with pre-existing conditions, it also continues its “death by a thousand cuts” approach to upending the nation’s health system under the ACA. The Centers for Medicare & Medicaid Services (CMS) has indicated to states that it supports state waivers to impose work requirements on “able-bodied” adult Medicaid beneficiaries (the Obama administration denied several similar state waiver requests).

To date, CMS has approved such waivers for Arkansas, Indiana, Kentucky, and New Hampshire, with seven other states waiting for approval. Such requirements require beneficiaries to certify that they have completed a certain number of hours of work or “community engagement” in order to be eligible for Medicaid; if they do not do so, they would lose their Medicaid benefits. Such waivers could potentially act as a barrier to coverage, especially considering that most Medicaid beneficiaries already are employed, while those who are not employed generally face significant barriers to employment.

These moves come even as more states realize the positive impacts of Medicaid expansion and as support for the ACA remains high. On Thursday June 7th – the same day, ironically, that DOJ filed its brief – Virginia Governor Ralph Northam signed into law a bill to implement Medicaid expansion, becoming the thirty-third state (plus the District of Columbia) to do so. This expansion, which will not be implemented until January 1st, 2019, provides Medicaid coverage to an estimated 400,000 additional low-income Virginians. Maine voters also voted overwhelmingly last year in favor of Medicaid expansion in the first ballot initiative to do so; Idaho, Nebraska, and Utah are also considering expansion through similar ballot initiatives.

ANA strongly opposes any attempt to weaken protections for Americans with pre-existing conditions to purchase health insurance coverage in order to receive critical healthcare services (the official ANA statement on this move can be found here), as well as any other attempts to erode the healthcare coverage for any segment of the population. These recent moves unequivocally demonstrate how out of step the Trump administration is with the American people when it comes to healthcare. Even as it attempts to take a wrecking ball to the gains made under the ACA, states are taking steps – with significant popular support – to shore up their own healthcare systems.

Healthcare stands to be a major issue in the 2018 midterm elections – 22 percent of respondents to a recent NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. The administration’s recent moves demonstrate just how much is at stake in these elections. ANA urges you to support candidates who uphold our core values and principles for health system transformation, as well as to engage with ANA’s Year of Advocacy and Hill Day 2018 activities (Hill Day 2018 will be held on Thursday June 21st). It is vital that nurses’ voices as the nation’s most honest and ethical profession and largest group of healthcare providers are heard in the public sphere and that nurses make their influence known.