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Daily Archives: January 4, 2018

Trump Administration Rule Paves Way For Association Health Plans

The Department of Labor on Thursday released proposed new rules that proponents say will make it easier for businesses to band together in “associations” to buy health insurance.

These rules, supporters say, will lead to more affordable choices for some small businesses and sole proprietors, likely starting in 2019.

Association coverage “should be cheaper and arguably just as comprehensive” as what many employers can now buy, said Christopher Condeluci, a Washington, D.C., attorney who specializes in employee benefits and has served as the tax and benefits counsel to the U.S. Senate Finance Committee.

Critics, though, are wary about whether the plans will provide consumers adequate protection.

“This approach allows associations to offer coverage that doesn’t have to come into compliance with all the critical consumer protections that would otherwise apply to small employers and individuals. It might not be as comprehensive,” said Kevin Lucia, project director at Georgetown University’s Health Policy Institute.

The proposal — which now faces a 60-day comment period — broadens the definition of those eligible to join or form such groups and rolls back some restrictions on association health plans set by the Obama administration.

Specifically, the rule would allow associations to be created for the sole purpose of offering insurance to members. In some cases, such associations could have members nationwide, making the insurance available across state lines.

For the first time, the rules would allow sole proprietors with no employees to join such group coverage.

Critics fear the rules could expose consumers to coverage gaps or higher out-of-pocket costs because these plans would be classified as “large-group plans,” so they would not have to meet some ACA rules.

For example, associations would not have to include benefits across 10 broad “essential” categories of care, including hospitalization, prescription drugs and emergency care. Under the ACA, large employers were exempt from these requirements because most already met them.

They would also be exempt from an ACA rule requiring insurers to spend at least 80 percent of premium revenue on medical care.

Georgetown’s Lucia and other policy experts warned that if plan eligibility is broadened and the plans are granted exemptions from some of the ACA’s coverage rules, they might siphon off the healthiest consumers. The result could drive up costs for small employers or individuals who buy insurance through the ACA market.

The National Association of Insurance Commissioners, for example, has previously warned that such plans “threaten the stability of the small group market” and “provide inadequate benefits and insufficient protection to consumers.”

Actuaries have made similar arguments.

Still, many ACA rules would apply to association plans, noted Condeluci. For example, plans could not reject employers based on the health status of their workers. And individual employees in a workplace could not be charged different amounts based on their health.

State authority over such plans would vary depending on whether the plans were self-insured, which exempts them from some state coverage and benefit rules, or fully insured, which means they must meet state mandates.

No matter how plans are funded, states would retain oversight of their solvency, said Condeluci.

But the proposal asks for additional comments on state regulatory authority.

States have historically had this oversight responsibility and maintained that they are best attuned to problems, concerns and consumer needs within their borders.

Whether the rule recognizes the importance of this role is a big concern,” said Lucia. âThe extent of state authority over these arrangements appears to be an evolving question for the Department of Labor.”

A GOP Go-To Health Policy

Republicans have long favored association health plans, seeing them as a way for small groups to get more clout with insurers.

One big proponent is Sen. Rand Paul (R-Ky.), who in October hinted that the Trump administration would soon move to expand access to such plans.

These plans have been around for decades, although enrollment has been more limited since the ACA’s passage. While some have worked well for their members, others have a checkered history.

A number have had solvency problems that left consumers on the hook for unpaid medical bills, while others have been fined for misleading advertising or failing to pay benefits.

Just this April, for example, Massachusetts regulators settled with Kansas-based Unified Life Insurance Company, which agreed to pay $2.9 million to resolve allegations that it engaged in deceptive practices, such as claiming it covered services that it did not.

The coverage “was sold across state lines and was issued through a third-party association,” according to a release from the Massachusetts attorney general’s office.

Other Key Elements

The proposed rule from the Trump administration would expand the definition of who can form and join an association.

It would allow associations to form for the sole purpose of offering insurance and enroll members from the same industry or region. “A plan could serve employers in a state, city, county, or a multi-state metro area, or it could serve all the businesses in a particular industry nationwide,” said the Department of Labor’s press release on the proposed rule.

Many such trade organizations pushed for looser rules.

“The National Restaurant Association applauds the administration for supporting healthcare options for small businesses to allow them to pool their resources to provide healthcare for their employees,” wrote Clinton Wolf, senior vice president for health insurance at the National Restaurant Association, in an emailed statement.

In allowing sole proprietors to enroll in association health plans, the proposal notes it would require such enrollees to actually be involved in an ongoing business, not merely offer a “single on-demand ride for a fee, or knitting a single scarf to be offered for sale on the Internet.”

“The rule is intended to cover genuine employment-based relationships, not to provide cover for the marketing of individual insurance masquerading as employment-based coverage,” the proposed rule says.

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Podcast: ‘What The Health?’ While You Were Celebrating …

The year in health policy has already begun: The Trump administration Thursday released a long-awaited regulation aimed at making it easier for small businesses and others to form “association health plans.” Now advocates and opponents will be able to weigh in with more specific recommendations.

Meanwhile, in December, the health policy focus was on the tax bill and its repeal of the Affordable Care Act’s “individual mandate” penalty for most people who don™t have health insurance. But some recent key court decisions could reshape the benefits millions of people receive as part of their health coverage.

This week’s What the Health?” guests are Julie Rovner of Kaiser Health News, Paige Winfield Cunningham of The Washington Post, Alice Ollstein of Talking Points Memo and Margot Sanger-Katz of The New York Times.

They discuss these topics, as well as the prospects for pending health legislation on Capitol Hill.

Among the takeaways from this week’s podcast:

  • The Trump administration’s decision to expand association health plans faces a number of obstacles, including the lack of good oversight in many states and the poor track record of many past plans.
  • Consumer advocates fear that growth of association plans could leave many consumers without adequate benefits because some plans will not cover the same essential benefits that Obamacare plans guarantee. They also are concerned that healthy customers will migrate to the new plans and leave the ACA’s marketplace plans with an abundance of enrollees who are ill.
  • The prospects of the bill to stabilize the individual insurance market sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) appear to be dimming.
  • Two federal judges have ruled against the Trump administration rule to change the ACA’s contraception mandate. The decisions, though, are not based on the policy but on faulty rule-making.
  • In another highly watched court case, a federal judge has ruled that the Equal Employment Opportunity Commission has until 2019 to set new rules on what employers can require of workers in their wellness programs.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week that they think you should read, too.

Julie Rovner: The New York Times’ “Care Suffers as More Nursing Homes Feed Money Into Corporate Webs,” by Jordan Rau (of Kaiser Health News).

Paige Winfield Cunningham: The New York Times “In Pursuit of Liquid Gold,” by David Segal.

ALSO: Bloomberg News’ “How Doctors Are Getting Rich on Urine Tests for Opioid Patients,†by Fred Schulte and Elizabeth Lucas (of Kaiser Health News).

Alice Ollstein: ProPublica’s Want to Lower Health Care Costs? Stop Wasting Our Money,” by Marshall Allen.

Margot Sanger-Katz: The New York Times’ “Unfiltered Fervor: The Rush to Get Off the Water Grid,” by Nellie Bowles.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher or Google Play.

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Viewpoints: The Medical Device Tax’s Comback; 2018 Brings Fresh Health Policy Choices, Controversies

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Thoughts On Curbing The Opioid Epidemic: Not All ‘Well-Intentioned’ Battle Plans Are ‘Good Ideas’

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Longer Looks: Crowdfunding Health Care; Why Humans Sleep; And Pseudoscience In Health

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State Highlights: N.H. Hospitals Hit Hard By IV Bag Shortages Linked To Hurricane Maria; Partners HealthCare’s Plan To Acquire Hospital To Get AG Scrutiny

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Depending On Where You Live In Minnesota, Medical Treatments Could Cost You 8 Times As Much

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Evolving Gender Roles, Shrinking Job Opportunities Are Helping Shift More Men Into Nursing

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Vast Geographical, Ethnic Disparities In Infant Mortality Continue To Plague U.S.

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Lawsuit May Upend Local-First Mentality When It Comes To Organ Donations

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