December 4, 2018
NASHVILLE --
While the American health care landscape continued to evolve in 2018, some of
the most significant changes were also those most prone to misunderstanding or
misinterpretation. Health policy expert Kev Coleman, president and founder
of AssociationHealthPlans.com,
offers his picks for the most misunderstood changes in health care this year.
1. The Impact of
Eliminating the Individual Mandate
Despite concerns about
a catastrophic effect on Affordable Care Act enrollment, eliminating the
individual mandate is unlikely to cause a large portion of enrollees to abandon
ACA coverage. That's because the vast majority of government exchange enrollees
(83 percent in 2018) receive subsidies that
dramatically reduce their costs. HealthCare.gov consumers receiving tax
credits paid an average monthly premium of $89, as opposed to the unsubsidized
average of $621.
"If you look at
the numbers, it's very unlikely people receiving subsidies will abandon ACA
coverage, even without the individual mandate," Coleman said.
"However, for the 17 percent of exchange enrollees who are unsubsidized,
the removal of the individual mandate combined with the cost of exchange
insurance will reduce enrollment.”
2. The Trump
Administration Plan for Lowering Drug Costs
When the Trump
administration unveiled a blueprint in May for lowering what
Americans pay for prescription medications, there was some confusion and
concern that all the proposals are set in stone. However, the proposals
contained in the blueprint are not guaranteed to be fulfilled. In fact, the
various initiatives within the blueprint fall into two categories: actions the
president may direct
Health & Human Services (HHS) to pursue, and actions HHS is actively considering.
"The scope of the
blueprint indicates that the Trump administration is not counting on a single
strategy to decrease drug costs but experimenting with a variety of measures,
any one of which may be unsuccessful or fail to be implemented," Coleman
said. "This broader approach reduces the chance of special interest groups
derailing the initiative as a whole.”
3. Reversing the
Three-Month Coverage Limit for Short-Term Health Plans
While the reversal of the three-month restriction in
October of 2018 garnered considerable press attention, more significant was the attendant change
that allowed states to permit short-term plan renewals or extensions for up to
36 months (without any medical underwriting or experience rating
past the initial sale of the policy).
"Within states
that choose to adopt the 36-month provision, we may see new short-term benefit
configurations since the longer duration changes the economics of these plans
for insurers," Coleman said. "Practically, this may mean additional
benefits in some plans or even limited pre- existing condition coverage.”
4. New Association
Health Plan Regulation
A June 2018 regulation
redefined the conditions under which associations can form and also opened up
association health plans to the self-employed and gig economy workers. The same
regulation introduced multiple measures to discourage fraud and mismanagement among
these plans. Critics of this new rule have predicted that associations will
offer "skinny benefit" plans. In reality, large group association
plans are still subject to state benefit rules as well as numerous federal
benefit requirements relating to issues such as maternity care, pre-existing condition coverage and preventive care.
"Since the new
regulation on association health plans has many facets, many health care
insiders are still learning how benefit requirements are determined by an
association's size, state of residence and whether the plan is self-insured or
insured through a third-party company," Coleman said. "As more
association plans are launched in coming years, understanding of their
mechanics will improve.”
No comments:
Post a Comment