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Trump Administration Creates Insurance Plans it Says are Affordable, Medical Ethicist Says are ‘Junk’
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A new battle has begun in the ongoing war between the Trump administration and most medical societies on what the definition of health care insurance should be.
According to HHS, while enrollment data showed stable enrollment for subsidized exchange coverage, the number of people enrolled in the individual market without subsidies dropped 20% in the U.S. in 2017 as premiums increased by 21%. The agency also said many state markets experienced “far more dramatic” enrollment declines, with unsubsidized enrollment dropping by more than 40% in more than 10% of the states, and by 73% in Arizona.
The departments of labor and industry, treasury and HHS used this as rationale for the final rule that they issued yesterday that enables the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than 3 months, according to a press release. Coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total.
“Under the Affordable Care Act, Americans have seen insurance premiums rise and choices dwindle,” HHS Secretary Alex Azar said in a press release. “President Trump is bringing more affordable insurance options back to the market, including through allowing the renewal of short-term plans. These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.”
CMS administrator Seema Verna agreed that the spiraling upward trend in health care costs had to be brought under control.
“We continue to see a crisis of affordability in the individual insurance market, especially for those who don’t qualify for large subsidies,” she said in the release. “This final rule opens the door to new, more affordable coverage options for millions of middle-class Americans who have been priced out of ACA plans.”
Within hours of the HHS announcement, the American Heart Association, American Diabetes Association and more than two dozen other medical societies joined to issue an announcement criticizing the new plans, arguing that the rule does more harm than good.
“Our organizations, representing more than 100 million American consumers, providers, and patients, are deeply troubled by the administration’s decision to finalize a short-term, limited-duration insurance (short-term) rule,” the joint statement read. “Despite serious concerns expressed by individuals and organizations across the entire spectrum of our health care system, the administration has finalized a rule that will reintroduce health insurance discrimination based on gender, health status, age, and pre-existing conditions.”
The medical societies accused the Trump administration of not paying attention to what most Americans want when it comes to this component of health care.
“A striking 98 percent of stakeholder groups who commented, including many of our organizations, either expressed extreme concerns with the rule or outright opposed it as drafted, emphasizing its negative impact on patients and consumers. The administration has disregarded those warnings and issued a final rule with few changes, aside from limiting renewals of short-term coverage to up to 3 years— which does nothing to resolve the fundamental problems with this policy.”
The groups also said the rule will slowly remove younger and healthier persons out of the individual risk pool, leaving patients with preexisting health conditions to pay “far higher” costs for the comprehensive coverage that they get through the insurance marketplaces and could leave younger, healthier patients holding the financial bag if they become critically ill.
ACP president Ana María López, MD, MPH, FACP, said her organization was “extremely disappointed” by the Trump administration’s action.
“This regulation will erode essential patient protections,” she said in a statement. “The regulation issued [yesterday] does not serve our patients well. ACP urges the administration and Congress to move forward in finding ways to increase the accessibility and affordability of truly comprehensive health care coverage that supports the best health outcomes for our patients.”
The American Academy of Family Physicians had not publicly responded to the final rule prior to this story’s posting, but had said during the comment period that although it saw some of the intent behind the administration’s rule, the Academy could not support it.
“We are troubled by how the proposed rule would further destabilize the individual market by drawing young, healthy people away from meaningful, comprehensive coverage," John Meigs Jr., MD, AAFP board chair, wrote in a letter sent to HHS in April.
“The AAFP strongly opposes the proposed rule since it allows plans to sell low-value insurance policies that could subject patients to catastrophic medical bills and medical bankruptcy. We oppose efforts to exempt short-term, limited-duration plans from consumer protections such as covering pre-existing conditions or essential health benefits. Furthermore, we oppose allowing any plans to establish caps on annual benefits since limiting benefits can expose patients to extraordinarily high out-of-pocket costs. This is particularly problematic for people who have chronic or life-threatening conditions that require costly treatment, close monitoring and ongoing medication.”
A medical ethicist concurred with the medical societies and said the reasons for the Trump administration actions are based on financial ones, not health ones.
“These plans are cheap because they do not cover much. The Trump administration is blinded by price,” Arthur Caplan, PhD, founding head of medical ethics at New York University School of Medicine told Healio Gastroenterology and Liver Disease.
“These plans are horrible,” he added. “None cover maternity leave, few cover prescription drugs or substance abuse treatment, mental health or diet plans for the obese. They will not cover pre-existing conditions. Renewal is left up to the insurance agency and there is no guarantee patients will be renewed. They are junk insurance that is likely to leave the sick and needy in the lurch.”
Memo Diriker, DBA, MBA, BS, and founding director of the Business, Economic, and Community Outreach Network at the Franklin P. Perdue School of Business at Salisbury University in Maryland, said in an interview concurred with some of Caplan's and the societies' sentiments, and also stated the insurance companies win under the rule, not patients and clinicians.
“This rule now makes it legal for insurance companies to offer health insurance policies that discriminate on the basis of gender, health status, age, and pre-existing conditions. It is a wonderful gift to insurance companies and their shareholders; it introduces a series of potential landmines for the customers buying these policies, and it is an absolute nightmare for the health care professional trying to provide the best and most appropriate care for their patients," he told Healio Gastroenterology and Liver Disease.
The rule takes effect 60 days from its publication in Public Register. Senate Minority Leader Chuck Schumer (D-N.Y.) said in a statement last night his fellow Democrats will “do everything in our power to stop the rule from taking effect.
“These new short-terms plans are ... so dangerous for Americans that it's no wonder not a single group representing patients, physicians, nurses or hospitals has voiced support,” he said. – by Janel Miller
Disclosure: Healio Gastroenterology and Liver Disease was unable to determine relevant financial disclosures prior to publication.