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What about our ubiquitous non-compliant plans?

March 29, 2021

Topics: Quote of the Day

March 25, 2021

From the Executive Summary

Our organizations represent millions of patients and consumers across the country who live with serious, acute and chronic health conditions. These individuals need access to comprehensive, affordable health coverage to meet their medical needs. In March 2017, we adopted a core set of principles to guide and measure any work to reform, change or improve our nation’s health insurance system. Our core principles are that health care must be adequate, affordable and accessible.

The enactment of the ACA has radically improved our patients’ experience with health insurance. Now, issuers are required to provide comprehensive coverage and prohibited from unfair coverage restrictions that discriminate against people with serious or chronic illnesses on the basis of their pre-existing condition.

However, over the past several years, new insurance rules have allowed issuers across markets to discriminate against people with pre-existing conditions as they did prior to the passage of the ACA. The proliferation of these non-ACA-compliant (non-compliant) plans has weakened the overall effectiveness of the ACA by exposing consumers, particularly those with pre-existing conditions, to significant financial risk, segmenting the individual market risk pool and unnecessarily inflating insurance premiums for people who rely on comprehensive coverage provided through the ACA marketplaces.

In comparison to the consumer protections that apply to ACA-compliant health insurance, non-compliant plans utterly fail to provide the same degree of certainty and security for patients and consumers.

This report endeavors to compile what is known about the most common kinds of non-compliant plans and make recommendations for Congress, the administration and state leaders.

The plans examined include:

  • Short-Term, Limited-Duration Insurance
  • Heath Care Sharing Ministries
  • Farm Bureau Plans
  • Grandfathered Plans
  • Misuse of arrangements subject only to non-ACA federal regulations (ERISA), including
  • Multiple Employer Welfare Arrangements and Association Health Plans
  • Spurious single-employer self-insured Group Health Plans (Data Marketing Partnership Scheme)
  • Minimum Essential Coverage-Only Plans
  • Excepted Benefit Plans

Recommendations for Congress:

  • Codify Short-Term, Limited-Duration Insurance (STLDI) Protections Into Law
  • Prohibit the Use of Brokers for Enrollment
  • Revise the Federal Definition of Insurance
  • Investigate Spurious Single-Employer ERISA Plans Arrangements
  • Require Employer Plans to Cover Essential Health Benefits (EHBs) and Adhere to EHB Standards
  • Require Issuers Selling Excepted Benefits to Confirm Enrollee is Covered by Comprehensive Coverage and Prohibit the Sale of Excepted Benefits that Mimic Fully Regulated Insurance

Recommendations for Federal Agencies:

  • Revise Federal Regulations Related to STLDI
  • Revoke Proposed Rule on Health Care Sharing Ministries (HCSM)
  • Rescind the Grandfathered Plan Rule
  • Rescind the 2018 Association Health Plan (AHP) Rule
  • Codifying the “Look Through” Doctrine
  • Clarifying the Term “Issuer”
  • Investigate Spurious Single-Employer ERISA Plans Arrangements
  • Vigorously Defend the Department of Labor’s Position in the Data Marketing Partnership Lawsuit
  • Ensure Sufficient Oversight of ERISA Plans, Including AHPs and MEWAs
  • Monitor and Collect Data on Large Employer Plans
  • Require Strong Disclosures of Limited Benefits

Recommendations for States:

  • Limit or Consider Prohibiting STLDI Plans
  • Require STLDI Plans to Meet Minimum Standards
  • Increase Transparency and Data Reporting for HCSM
  • Prohibit Sales Through Brokers
  • Maintain or Reestablish Authority Over Farm Bureau Plans
  • Strengthen Licensing Requirements for AHPs
  • Ensure Sufficient Oversight of AHPs and MEWAs
  • Investigate Spurious Single-Employer ERISA Plans Arrangements

This report was compiled on behalf of the following members of the Partnership to Protect Coverage:

  • The AIDS Institute
  • The Alpha-1 Foundation
  • ALS Association
  • American Cancer Society Cancer Action Network
  • American Diabetes Association
  • American Heart Association
  • American Kidney Fund
  • American Liver Foundation
  • American Lung Association
  • Arthritis Foundation
  • Asthma and Allergy Foundation of America
  • Cancer Support Community
  • Chronic Disease Coalition
  • Cystic Fibrosis Foundation
  • Epilepsy Foundation
  • Hemophilia Federation of America
  • JDRF
  • The Leukemia & Lymphoma Society
  • Mended Hearts & Mended Little Hearts
  • Muscular Dystrophy Association
  • National Alliance on Mental Illness
  • National Hemophilia Foundation
  • National Kidney Foundation
  • National Multiple Sclerosis Society
  • National Organization for Rare Disorders
  • National Patient Advocate Foundation
  • Pulmonary Hypertension Association
  • Susan G. Komen
  • United Way Worldwide
  • WomenHeart: The National Coalition for Women with Heart Disease

Full report – 26 pages:
https://www.lls.org…


Comment:

By Don McCanne, M.D.

Those who believe that the Affordable Care Act took care of the deficiencies in health plans and that all we need to do is expand existing coverage need only remind themselves of the non-compliant plans listed in the middle of the excerpts above. The organizations sponsoring this report certainly recognize the deficiencies of the non-compliant plans.

It is interesting to look at the fairly extensive list of recommendations they have for correcting the deficiencies of non-compliance. It seems that it would be more logical to enact and implement single payer Medicare for All than to try to apply patches to a system with a fundamentally flawed financing infrastructure, especially when you consider the multitude of other patches that would be required that would still fall far short of the impossible task of correcting the major deficiencies in affordability, efficiency, universality, and especially equity. We really need Medicare for All to do that.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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