Major physician and patient groups argue that a Trump administration proposal to expand use of skimpier insurance plans by healthier consumers would cause premiums to spike for people with serious health conditions. And, those who buy the scaled-back medical coverage could face unmanageable costs if they fall ill, the groups said.
The Centers for Medicare and Medicaid Services (CMS) intends to expand the period of time during which consumers can use so-called short-term plans to “less than 12 months” from a current cut-off of less than 3 months. These plans are not required to meet the demands of the Affordable Care Act (ACA) of 2010. Known as short-term, limited-duration insurance, these plans have so far often served as a stopgap solution for consumers.
But CMS’ proposed rule would make “short-term” a misnomer, as the plans would be renewable, wrote James L. Madara, MD, chief executive officer of the American Medical Association (AMA), in a formal comment offered Monday.
The AMA had asked CMS to withdraw this rule, seeing this regulatory proposal as likely to have major consequences on Americans’ ability to secure health insurance. The expanded use of skimpier plans would “undermine the individual insurance market and create an uneven playing field by luring away healthy consumers, thereby damaging the risk pool and driving up premiums for consumers left in the ACA-compliant market,” Madara writes.
“The AMA strongly believes that an important federal role remains to ensure that proposals to foster competition in health insurance also promote ACA marketplace stability and a balanced risk pool, and do not lead to adverse selection in the marketplace,” Madara noted.
CMS contends this proposed change will benefit consumers who purchase scaled-back plans because they would get lower premiums. In the proposed rule, CMS noted that the average monthly premium in the fourth quarter of 2016 for a short-term, limited-duration policy was approximately $124 compared with $393 for an unsubsidized plan that met the requirements set by the ACA.
Coverage not “Adequate”
The AMA and the American Academy of Family Physicians (AAFP), in their separate comments to CMS about the proposed rule, stressed the risks for the consumers who buy the skimpier plans. In the proposed rule, which CMS released in February, the agency said it would require a “notice” in 14-point type to urge consumers to understand what the skimpier plans wouldn’t cover.
“While we appreciate that [the US Department of Health and Human Services (HHS)] acknowledges that a warning is needed, we also note that its very existence argues against the creation or promotion of short-term, limited-duration insurance plans,” John Meigs, Jr, MD, chairman of the AAFP board, wrote in a comment to CMS. “We strongly encourage HHS to instead focus on enrolling people into insurance plans with robust and ACA-compliant coverage.”
In joint comments offered to CMS, the American Cancer Society Cancer Action Network and about 20 other groups, including the American Heart Association, asked CMS to consider what would happen to people who develop life-threatening conditions while covered by less extensive insurance plans. They noted that this happened more frequently before the ACA mandated essential health benefits (EHB) for plans.
People would find out that they were not covered for new treatments or emergency room care or even life-saving medications, wrote the groups, which also include the American Lung Association and the March of Dimes, in their comments to CMS.
“Many of these individuals did not realize at the time of their enrollment that they had selected a plan that did not meet their health care needs, let alone provide adequate coverage for a new diagnosis,” the groups wrote. “Individuals with and without pre-existing conditions have come to rely upon the foundation that EHBs provide for adequate health insurance, and they expect those services to be covered by their insurance.”
The trade group for the health insurance industry also raised objections to the CMS proposal.
In a press release, America’s Health Insurance Plans (AHIP) said it asked CMS to limit the duration of short-term plans to 6 months. The trade group said that consumers need to know that short-term plans may not cover treatments for pre-existing conditions. These plans also may not cover preventive care, prescription drugs, mental health care, or treatments for chronic health conditions such as diabetes or heart disease, AHIP said in its statement. And, these plans may impose annual, lifetime, or daily limits on coverage, the group said.
“Short-term plans can provide an important temporary bridge for Americans who are transitioning between plans,” said Matt Eyles, incoming president and chief executive of AHIP, in the statement. “But they are not a replacement for comprehensive coverage.”
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