Get Set For Trump Revisions To Your Affordable Care Act Insurance

Get Set For Trump Revisions To Your Affordable Care Act Insurance

April 13, 20175:00 AM ET
Julie Appleby

The Trump administration is proposing changes to Obamacare that the White House says should stabilize the insurance marketplace. But critics of the proposal see big bumps ahead for consumers.

Repeal and replace is on-again, off-again, but that doesn't mean the rules affecting your insurance will stay the same in the meantime.

The Trump administration's proposed rule aimed at stabilizing the existing health law's insurance marketplace could have rapid, dramatic effects — perhaps as soon as early summer — on people who do not get insurance through work, and buy it on the Affordable Care Act's exchanges instead.

If the changes the administration proposed in February hold up in the final draft — which is expected out soon — look for a shorter enrollment window, tighter vetting of people who sign up outside of those open periods and efforts to penalize consumers who don't maintain "continuous coverage."

The controversial proposal by the Department of Health and Human Services drew letters from nearly 4,000 organizations and individuals during an unusually short, 20-day public comment period that ended in early March. Consumer advocacy groups hate the proposal, saying it would wreak havoc by making it harder to get coverage.

But some specialists in the health law, including Christopher Condeluci of CC Law & Policy in Washington, D.C., see the HHS proposal as helpful for insurers, though he also thinks more adjustments are necessary.

"Does it meet all the carriers' asks when it comes to what changes are needed? No, I don't think it goes far enough," said Condeluci, a former staffer to the Senate Finance Committee who specialized in insurance issues.

Sabrina Corlette, an attorney who studies the individual marketplace for the Center on Health Insurance Reforms at Georgetown University, said the directive could result in fewer healthy enrollees – which insurers also would not like – and don't address some of the biggest concerns for the insurance industry, such as the fate of federal subsidies that help low-income consumers pay deductibles and other out-of-pocket costs.

The Trump administration's proposal, Corlette said, is "nibbling away at the margins."

Here are four ways the stabilization rule might change the individual health insurance market:

If you owe, you pay first

Under the proposed rule, consumers who want to sign up for an ACA plan with their same insurer for 2018 would have to repay past-due premiums from the previous 12 months before being granted new coverage. Because Obamacare has allowed a three-month grace period before people who haven't paid premiums are kicked out of coverage, a consumer's overdue premiums could tally hundreds of dollars — even more than $1,000.

Trump's proposed change aims to discourage people from gaming the system. Insurers say a person with a bad knee, for example, might enroll and pay just long enough to get an expensive knee replacement, then stop paying premiums.

But wait, consumer groups and the National Association of Insurance Commissioners warn.There might be legitimate reasons people stop paying premiums — billing errors that are not the fault of the consumer, for example, or the loss of a job. By making such a change, the groups argue, the Trump administration would violate a key part of the health law that requires insurers to offer coverage to just about everyone who applies.

Under Trump's proposed change, "only those who can rapidly come up with a possibly significant sum of money by a given deadline can be guaranteed access to coverage," wrote Families USA.

Some insurers have recommended broadening that proposal to include "unpaid premiums for any prior coverage year."

Better act quickly

Open enrollment this fall (for 2018 health insurance coverage) would shorten to six weeks, down from three months. While opening day would remain the same — Nov. 1 — the proposal would close the marketplace on Dec. 15 instead of at the end of January. That period "provides sufficient time for consumers to enroll," the administration has said, and would mean all who sign up would have a full year of coverage starting Jan. 1.

The shorter time period, the administration said, could also reduce the number of people who wait to enroll until after they find out they have a health problem. These late joiners are likely to use more health care than a healthy person their age, insurers and the Trump administration say, and can drive up the cost of insurance to everyone.

Consumer groups argue the Trump proposal could backfire, because those who tend to wait until the last minute to sign up are actually often the youngest and healthiest – and they may miss the enrollment window if it is shorter. Additionally, the proposed deadline falls around the holidays, when money and time are often tight, which could have a chilling effect on insurance sign-ups.

Prove you have a reason — and maybe prior coverage

The ACA allows people to sign up outside the open enrollment period for a variety of special reasons, such as moving, losing coverage, getting married or having a child. This provision has always been a sticking point with insurers, who have maintained that too many customers who made a change during the special enrollment period were sicker and costlier than average. In response, the Obama administration tightened some of these requirements last year and announced it would run a pilot program starting this summer to randomly select half of all special enrollment applicants for verification review, holding up the applicant's insurance coverage until they provide the proper documentation.

Under the Trump administration's proposal, 100 percent of those applications would be required to undergo preapproval verification – beginning in June 2017. Consumers would have to provide documentation proving they qualify for special enrollment before getting coverage. The administration also proposes that for marriage, at a minimum, one member of the couple would have to prove they had health coverage for at least one day in the two months before their nuptials.

Consumer groups are unhappy with the pre-verification idea – and the extra requirement for prior coverage of people who are getting married. Particularly hard hit would be couples who were uninsured previously because they could not afford health insurance as singles — or could not get it under their state's Medicaid rules. Additionally, consumer advocates and some regulators say requiring newlyweds to prove prior coverage violates the health law.

Still, the Trump administration asked whether continuous coverage rules should be extended to all special-enrollment customers, not just those getting married. Perhaps people should prove they had coverage for the previous six to 12 months, the administration suggested, or else face a waiting period or financial penalty.

Flexibility – or higher deductibles?

The health law uses a complex formula to divide plans into metal tiers — bronze, silver, gold and platinum — based on an average percentage of a typical year's health care bills each level of plan covers. Bronze plans, for example, currently must cover an average of 60 percent of costs, while a silver one is 70 percent – and insurers are allowed wiggle room of plus or minus 2 percent around those averages.

The Trump proposal would tweak the formula, allowing insurers to create plans with larger variations around the average. (It exempts certain silver plans for low-income consumers from the change.) So, for example, a bronze plan might cover only 56 percent of costs and silver 66 percent. Insurers say this would allow them to create plans that appeal to more customers, particularly those looking for lower premiums. But critics say the move would increase the size of deductibles.

One big problem in boosting enrollment has been that many potential consumers — particularly younger, healthier ones — say premiums are too high. But adjusting the law in this way could raise deductibles and other cost-sharing requirements, which consumers may dislike even more. While the health law sets a maximum cap per year on such payments, for many people those deductibles are already thousands of dollars annually. Under the proposal, deductibles could increase by more than $1,000 a year, according to an analysis by the consumer advocacy group Families USA.

Please, may I have some more?

Topping insurers' wish list for other changes — which would require legislative action by Congress — would be permanent federal financial support for insurers that face high-dollar claims from some policyholders. Insurers have argued that change is important if they are to hold down premium costs across the board. Insurers also want a surcharge for people who let their coverage lapse, and the permission to charge older people five times more than younger ones, a practice known as "age rating." The current limit is 3:1. Widening that ratio could lower premiums for young people but cause big hikes for people older than 45.

Cigna said it would like to see an "appropriately funded system of state-designed high-risk pools," where people with costly illnesses could be sent. So, those with cancer, heart disease or other illnesses would be shunted into those pools, reducing spending — and perhaps premiums — for all remaining in the regular pool. High-risk pools historically, however, have been underfunded, often leading to expensive premiums for enrollees, long waitlists or annual limits on care.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

http://www.npr.org/sections/health-s...-act-insurance

You can't fix Obamacare. It was rotten from the Git Go. Yes, it helped some people. It sure did. But there were far easier, cheaper and simpler ways to do it. You can't design a national health insurance plan catering to the insurers. You can't make the numbers work for the insured when you pigeon-hole small groups of people. You can't make health insurance affordable when you don't have fair trade practices or interstate national markets. You can't achieve the economies or size of the group when you have 75 million people on Medicaid, another 15 million on SCHIP and 55 million on Medicare. You can't tell the individual market to play by one set of rules and those with company-paid health insurance by another set of rules. You can't lure customers by force and have a good outcome. You can't tell Americans to sign up or else.

Start with these few simple principles:

1. Free people in a free nation
2. Everyone operates according to the same rules, individual, employer-paid, or government-funded
3. Remove the income tax from the equation, entirely (no tax credits, no HSA's, no mandates with tax penalties)
4. All companies and suppliers subject to the Sherman Anti-Trust Act
5. Government's role limited to protect consumers from anti-competition, deception, fraud, and unfair trade practices
6. Every legal citizen/resident pays the same price for the same medical care regardless of who you are or who is paying for it

Unless your "rules" achieve these 6 basic free, equal and fair business principles, your "plan" isn't going to work in the United States.

Just ask yourselves, why are insurance companies, the AMA, and hospitals all on the same side? Why aren't insurance companies blaming the AMA and hospitals for outrageous prices on medical care that shoots up the cost of insurance? Why aren't hospitals and doctors attacking the insurance companies for outrageous insurance rates that create the "uninsured" who need medical care but can't pay for it? Why do they all line up with their hands out for taxpayer funded subsidies and expanded Medicaid and SCHIP?

That's right. COLLUSION. Why do they get away with it? McCarran-Ferguson Act of 1945. REPEAL THAT SOB and get this show on the road. SENATE: DO YOUR JOB and repeal that piece of crap. House has finished it's work, now you do yours.

I'm afraid that is right. It is collusion. That's why the Obamacare plan was so convoluted and unfathomable. Ever one of these entities wrote their own 'goodies' into the bill and what came out was ludicrous.

Why not just scrap it all. Let people buy their own coverage - give deductions for premiums (they used to do this), and we will always have Medicaid and Medicare. d

Send the illegals home -

For those with pre-existing - while I have some reservations about people demanding someone else pick up the tab for them, I realize it must be done. Why not, then, have some kind of plan that all insurance companies have to participate in to cover this.

For liability auto insurance in Texas, we have - did have - what is called an 'Assigned Risk Pool'. One must have liability insurance or in other ways be 'financially responsible' (bond,money on deposit, etc.). Some people have such a poor driving record, they are no longer insurable under normal policies - so they purchase their insurance through the 'assigned risk pool'.

Again, while I know people must get medical care, I don't really like the idea of people simply making the choice to spend their money elsewhere and want someone to bail them out when they become ill. It just doesn't set well with me. Also, I can see circumstances beyond one's control could cause this as well -

The ant and the grasshopper -

The government has never gotten involved in private enterprise that it didn't totally destroy it, cost people more, and make more room for fraud and theft.

Exactly. To fix the problem of uninsured, we need jobs. To fix the problem of jobs, we need to pass the FairTax, deport illegal aliens, stop legal immigration, and fix our bad trade deals. To fix the problem of vertical collusion, we need the repeal of the McCarran-Ferguson Act.

And that's all we need to do to fix "health care" in the United States.

I wish I understood exactly what the McCarran-Ferguson Act is and how it applies to insurance.

Quote:

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Originally Posted by nntrixie

I wish I understood exactly what the McCarran-Ferguson Act is and how it applies to insurance.

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Let me try to explain it. It's novel, because it doesn't apply to any other industry or business in the United States, so most people can't get their minds around it.

In 1945 there was a US Supreme Court ruling that made it clear that the insurance industry was subject to the Sherman Anti-Trust Act even if they were regulated by a state. The Sherman Anti-Trust Act prevents collusion, price-fixing, industry wide plots, schemes, fraud, deceptive trade practices and other unfair business and trade practices if you do business across state lines and are therefore part of interstate commerce. The insurance industry like all industries all do business across state lines, even if they aren't selling across state lines, they're buying products and services across state lines. In an Anti-Trust case, that went all the way to the US Supreme Court, they argued they were exempt from Sherman Anti-Trust and federal law because they were regulated by a state insurance commission (the center of insurance collusion condoned b a state). The US Supreme Court said, "uuuh, no, the fact that you're regulated by a state has no bearing on interstate commerce and federal regulations of that commerce including the Sherman Anti-Trust Act.

In response to the insurance industry losing this US Supreme Court Case, the US Congress immediately passed a law to exempt the entire insurance industry from the Sherman Anti-Trust Act "if regulated by a state", that bill that exempted the entire insurance industry in the US from all the consumer protections of the Sherman Anti-Trust Act, "if regulated by a state", is the McCarran-Ferguson Act of 1945.

Until the 1980's, it didn't matter very much, because 83% of Americans had health insurance through their employers or a spouse/parent employer. So it was a small number of people who were subjected to the schemes and scams, UNTIL, hey day pay day came with FREE TRADE TREASON, and all the jobs lost from that left millions of Americans without access to employer insurance coverage and created this "individual market" that they couldn't afford or didn't qualify for due to pre-existing conditions, or were dropped from coverage if they ever used it, and all the other unfair harmful tricks of the health insurance industry in particular. Health insurance companies are kept honest by employers because employers with hundreds, thousands, tens of thousands and even at that time hundreds of thousands of employees have clout, and power to negotiate and keep the insurance company honest as far as their plans are concerned, but an individual out there shopping for insurance, has no clout and no power at all, except to say, "oh, wow, I can't afford that, thank you anyway" and off they go into the realm of the uninsured.

As the unemployed number grew, the uninsured number grew, so the insurance companies are saying, "damn it all, we're not getting these people signed up and we want their money", so what do you do? You get the government to FORCE THEM to sign up, you get the government to underwrite part of it, and the "hey day, pay day" is full steam ahead, or so they thought, but it didn't work, it back-fired on them, as excess greed in a free nation of free people usually does.

So Obamacare is collapsing. The insurance industry is caught up in its own madness, not able to decide what to do. They know and have always known that repealing McCarran-Ferguson would solve the problem, but they would rather cling to the protections for their bad acts that McCarran exemption affords them than fix the problems of their industry, which spans all through the entire medical care industry. Insurance companies invest in stocks so they invest in the hospital stocks, the medical equipment stocks, the pharmaceutical companies as do doctors and hospital retirement funds, including those of all the 501 C 3 "charity" fraud hospitals, so they all collude together, all lobby together, plan together, scheme together, and can do so, because of the insurance industry provided by McCarran-Ferguson Act exemption from the Sherman Anti-Trust Act.

When you repeal McCarran-Ferguson, you solve 95% of the problem with health insurance. You still have to solve the jobs problem, but that is a different issue. They are tied together right now when they should be completely separate, because of Obamacare and the mandates that harm innocent individuals who can't afford or don't want health insurance and employers who for their own reasons can't afford or don't want to provide company-provided health insurance. Obamacare LINKED it all, and it all needs to UNLINKED, everyone set free, individuals and employers, and the insurance industry governed and regulated like every other business and industry in the United States that's subject to the Sherman-Anti Trust Act that keeps all businesses and industry competitive and operating with fair trade practices when doing business across state lines, either in sales or buying of products and services, or both.

McCarran-Ferguson's "gotta go".

The bill to repeal McCarran-Ferguson Act passed the US House of Representatives almost a month ago on March 22, 2017, and not one MSM cable news, network, printed press or any other member of our media said one word about it. I discovered it by accident following up on a statement by a Congressman I heard in a Fox News shows who told the stupid interviewed "we've already passed the repeal of McCarran" and of course the interviewer just blipped right on by it as if it were nothing, and I thought did I hear him right? So I googled and discovered it only from posted press releases from the insurance industry associations giving notice to their members that the House had passed the repeal bill, 416-7, an unprecedented vote for any type of major legislation, but only removes the exemption for the health insurance industry. Life, property and casualty, auto, etc., are still exempt.

I don't even know if Trump knows. Bannon may not even know. Otherwise, someone would have declared this a victory for Trump, because "erasing the lines" was such a major part of his campaign. Maybe Bannon knows but didn't tell anyone.

Someone needs to tell Trump so he can Tweet it out and let everyone know the biggest secret in DC which is the US House of Representatives "erased the lines" with a record bi-partisan vote. It's now in the US Senate. The bill is Paul Gosar's bill, HR 372.

And if you want the same good results from competition and fair trade practices, I would immediately demand a full repeal of McCarran-Ferguson to obtain these good results for all insurance companies and their consumers.

They didn't want to boggle the debate this time with the other insurance companies and delay the process of passing the Phase 1 health care bill.

I hope this helps explain why the repeal of McCarran-Ferguson is so important to fixing our country.

I know I am being dense - but I'm not sure exactly what the insurance companies did, that was considered an anti-trust matter.

Truly, I don't understand.

I do understand the insurance companies lost a lot due to offshoring, illegals taking jobs, etc., as they lost a lot of group plans.

I also know many went out of business because the government passed laws forcing them to offer coverage they could not offer and still keep their premiums down.

This in effect kept people from having a choice of the type of coverage and the cost of their plan.