97 Patient Groups Object to Short-term, Limited-Duration Proposed Rule
Today, the I Am Essential coalition, submitted comments, signed by 97 patient groups, to the U.S. Department of Health and Human Services in opposition to the Trump Administration’s proposed rule that would expand the scope and applicability of short-term, limited-duration insurance plans (short-term plans). The rule, if finalized, would have a crippling effect on individuals’ healthcare, particularly those living with chronic and serious conditions, since the plans would not be subject to the regulations and requirements of the ACA and could expose beneficiaries to harmful practices and substandard health benefit design. Additionally, it would have long-lasting implications on the stability of the health insurance market.
In the I Am Essential letter the patient groups write that the proposed rule redefines “short term” plans in such a way that makes them appear to be comprehensive health insurance. Currently, they are meant to be stop-gap insurance for up to 3 months. The proposed rule would extend them to 364 days, with an opportunity for renewal.
Additionally, these plans are not required to provide the patient protections beneficiaries are now accustomed to such as the ten essential health benefits. The patient groups write that restricting access or excluding such things as prescription drug coverage, mental health and substance abuse services, or hospital emergency coverage will simply, “leave beneficiaries paying monthly premiums for substandard coverage without any guarantee of protection or access to health care.”
“Even if the plan indicates it covers a certain essential benefit, the breadth of that service can fall short of what patients need and plans can place artificially low limits on the number of visits or prescription medications. Plans would not have to follow existing regulations that require their formularies to cover at least the same number of drugs in each state’s benchmark plan, consider newly approved medications, utilize Pharmacy and Therapeutics Committees for formulary review, or follow prevailing treatment guidelines.”
Short-term plans would also be allowed to cherry pick beneficiaries by excluding those with a pre-existing condition.
The proposed rule would require a disclaimer, warning consumers that short-term plans do not qualify as health coverage or minimum essential coverage. However, I Am Essential fears that, “since short-term plans give the illusion of coverage, and will carry lower premiums than ACA compliant plans, people will most likely gravitate to them, particularly if marketing methods do not fully communicate the limitations and risks.”
Furthermore, the proposed rule will have broader effects on the health insurance market. By draining the ACA market of healthy individuals, I Am Essential writes, “Short-term plans will undoubtedly deplete the ACA-compliant market of younger, healthier individuals, essentially creating two risk pools; the high-risk, ACA-compliant market, and a pool of healthier people in short-term plans.” This proposed rule, combined with the recently proposed Association Health Plan rule and the elimination of the individual mandate will work to destabilize the ACA Marketplace with patients bearing the brunt of the impact.
The I Am Essential letter concludes, “redefining short-term plans, as proposed, would take away comprehensive health benefits and patient protections, increase healthcare costs on individuals and the healthcare system, and put greater strain on the individual health insurance market.”
Signatories to the letter include The AIDS Institute, American Autoimmune Related Diseases Association, Arthritis Foundation, Cancer Support Community, Epilepsy Foundation, Human Rights Campaign, National Multiple Sclerosis Society, National Alliance on Mental Illness, National Hemophilia Foundation, National Patient Advocate Foundation, National Psoriasis Foundation, and Vietnam Veterans of America.
The full text of the comment letter and list of 97 signers can be viewed here.
The “I Am Essential” Coalition is a broad group of patient and community organizations representing millions of patients and their families. The Coalition strongly supports access and coverage for the healthcare needs of individuals living with chronic conditions and disabilities. I Am Essential works to ensure health plans provide quality and affordable Essential Health Benefits and to strengthen patient protections in the evolving health care landscape.