March 13, 2019
Dive Brief:
- The House Committee on Energy and
Commerce is launching an investigation into short-term health plans that
critics derive as "junk" plans, Chairman Frank Pallone, D-N.J.,
announced Wednesday. The committee will look into what the plans cover,
their business practices, advertising strategies and their popularity with
consumers.
- Leading Democrats kicked off the
joint inquiry by requesting documents and information from 12 companies
that either sell, market or assist consumers in signing up for the
short-term, limited-duration coverage, including market giants Anthem and
UnitedHealth Group.
- The Trump administration expanded short-term health
plans last year, a move that Affordable Care Act
supporters blasted as sabotage. The skimpy coverage isn't required to
cover the 10 essential benefits of the ACA, including behavioral health,
substance use treatment and maternity care. "We're going to
investigate these plans and hold them accountable," Pallone said
Wednesday at the America's Health Insurance Plans 2019 National Health
Policy Conference.
Dive Insight:
Short-term
plans, originally designed to be a low-cost, temporary safety-net and only
available for three months, were expanded for the 2019 plan year, making it
easier for insurers to market them as cheap alternatives to ACA plans. Short
term plans can now last 12 months (and can be renewed for up to three
years) and are open to anyone, not just young people or those who can't
afford other coverage as originally intended.
As
an additional wrinkle, a 2018 Kaiser Family Foundation
report found short-term plans could destabilize the ACA
exchange market, creating higher premiums for full-coverage plans and leaving a
greater number of people uninsured.
Patient
advocates and Democrats generally oppose the plans, which aren't required to
meet the minimum standards for coverage under the ACA. Millions of Americans
with pre-existing conditions could be saddled with a plan that doesn't cover
their essential care and could see their out-of-pocket costs rise.
"Patients
think [junk] plans comply with the protections of the Affordable Care Act, but
insurers and brokers in some cases are selling junk plans that mislead
consumers about the details of the plans and their policies," Pallone
said.
Health
Subcommittee Chairwoman Anna Eshoo, D-Calif., and Oversight and Investigations
Subcommittee Chairwoman Diana DeGette, D-Colo., will also take part in the
probe.
One
case exemplifying the concerns is Hollywood, Florida-based Simple
Health Plans, an insurer shut down by a federal judge after selling
what the Federal Trade Commission deemed "worthless" plans to
thousands of patients, leaving them saddled with major medical expenses.
Last
month, four Democratic senators introduced the Protecting Americans with
Preexisting Conditions Act of 2019, which would require the Trump
administration to roll back its October policy allowing taxpayer subsidies and
support for health plans that don't provide comprehensive coverage.
Under
the guidance, states can
increase out-of-pocket maximums and weaken health benefits for their residents,
according to a December letter sent to the HHS, CMS and the treasury from 42
senators. Multiple states, including California and New York, forbid the
sale of short-term plans.
An
Energy and Commerce statement cited one company that refused to pay for a
patient's cancer treatment, leaving him with an unexpected $800,000 in medical
bills.
Along
with documents, the investigation heads are requesting answers to a series of
questions, including what percentage of applicants are denied coverage and why,
how the plans are marketed, how much commission agencies and brokers are paid,
and whether they engage in post-claims underwriting, a practice that can leave
patients on the hook for the price of care that should be covered.
Following
Pallone's announcement, AHIP CEO Matt Eyles pledged the national trade
association's support for comprehensive health insurance. "Our industry is
fully behind making sure everyone has coverage," Eyles said. "That
includes pre-existing conditions."
Along
with Anthem and UnitedHealth, the other companies under investigation are Agile
Health Insurance, Arkansas Blue Cross Blue Shield, Blue Cross Idaho,
Cambia Health Solutions, eHealth, Everest, Health Insurance Innovations,
Healthcare Solutions Team, Independence Holding Company and National General
Accident and Health.
Four
are members of AHIP.
https://www.healthcaredive.com/news/house-panel-to-launch-investigation-into-short-term-junk-plans/550435/
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