Association Health Plans: What’s Next?

June marked the implementation of a regulation focusing on Association Health Plans (AHPs) and the benefits they may offer small businesses and self-employed individuals within the same industry or profession. Click here for a breakdown of this final ruling by our legal team at Steptoe & Johnson.

The Council Perspective: AHP expansion rests on the idea that these groups will come together to buy more affordable health insurance as an alternative to the ACA. However, AHPs have historically been riddled with scandal, resulting in the creation of state-specific regulations aimed at avoiding insolvency, higher premiums and fewer plan choices.

Notably, the U.S. Department of Labor regulation does not alter any state authority to regulate multiemployer welfare arrangements (MEWAs), of which AHPs are one type. Consequently, whether AHPs gain any traction will likely be up to the states and how they choose to regulate the plans (12 states have already filed lawsuits aimed at striking down the new regulation). In addition, professional and trade associations, small businesses and other groups will have to wait to determine if insurance carriers choose to offer AHP plans at all. Thus, brokers looking to offer AHPs are operationalizing strategies in an uncertain environment.

 

 The Single-Payer Movement: Where Are We Now?

When Bernie Sanders (I-VT) introduced “Medicare for All,” two starkly different voices emerged on the issue.

The Council Perspective: One voice has questioned how Medicare for All will be funded, and noted that the proposed system would actually restrict options, limit access, stifle inflation and increase costs. The other has argued that a one-size-fits-all, government-controlled health care system would solve issues like rising healthcare costs and access to appropriate, timely care. However, both sides agree that too many families struggle with rising premiums, too many individuals struggle to get the care they need when they need it, and too many treatments are often out of reach.

This year, healthcare ranked as the number one issue candidates are highlighting in their campaigns. While Medicare for All may seem like a partisan debate, most moderate Democratic candidates are attempting to rally support by advocating for the improvement of the ACA, emphasizing that the most effective solution would be to fix the current healthcare system to avoid interrupting coverage for millions of Americans. So far, this tactic has worked for Democrats in Texas, Indiana and Maryland. Although more than half of Americans support some type of national health plan, according to Kaiser, there is less agreement on what a ‘government-funded healthcare system’ looks like, which has eroded support among Americans.

Click here for our federal and state single-payer legislation trackers, and other related materials.

 

Related Materials:

The Council’s State and Federal Legislation Trackers

The Future of Health Care: Where Does the Bipartisan Path Lead?
Bipartisan Policy Center

Seventy Percent of Americans Support ‘Medicare for all’ in New Poll
The Hill

Why ‘Medicare for all’ is Playing Poorly in Democratic Primaries
Politico

 

 Short-Term Health Plans, Long-Term Issues

On August 1, the Trump administration unveiled new regulations for short-term health plans, which are not subject to the ACA’s market reforms, like providing maternity and mental healthcare benefits or guaranteed coverage for people with pre-existing conditions.

The Council Perspective: Short-term health plans—previously established as three-month ‘stopgaps’ under the Obama administration—may now last up to 364 days for the initial contract term. The total duration of coverage, including the initial term and any renewals and/or extensions, may last up to 36 months. Some at the state and federal level argue that the plans are an affordable alternative to ACA coverage; however, states like Maryland, Vermont, Illinois and California are working to impede the new rules. State concern stems from short-term plans’ failure to cover particular conditions.

 

 Listening In: A Conversation with Seema Verma, CMS

Leavitt Partners, a Salt lake City-based healthcare consulting firm, hosted a conversation with Center of Medicare and Medicaid Services (CMS) Administrator, Seema Verma, about value-based healthcare.

Here’s what we learned:

  • Next Generation Accountable Care Organizations (ACOs), which require physicians to take on almost complete financial risk, saved Medicare $62 million during their first year of operation.
  • Despite a focus on tying payments for care to the quality of care provided and rewarding providers for efficiency and effectiveness, the fee-for-service model is not going away right now.
  • To support Next Generation ACOs, the main goals are to promote accountability and competition, increase regulatory flexibility, which rewards providers for taking on substantial financial risk, and promote patient engagement with access to healthcare data as well as cost and quality information.
  • The next step is to address the barriers to value-based care, including interoperability, meaningful measures (i.e., the quality measures that providers report), and supporting technology and communication innovation efforts.
  • Support from the private sector is necessary in the long-term success of value-based care initiatives.

 

Joel Wood, SVP, Government Affairs
GOP Senators Introduce Bill to Preserve Obamacare’s Pre-Existing Conditions Protections
The Hill

Joel Kopperud, VP, Government Affairs
Why a Patient Paid a $285 Copay for a $40 Drug
PBS NewsHour

Cheryl Matochik, SVP, Strategic Resources & Initiatives
Geisinger, Merck Partner to Launch EHR-Integrated FHIR Apps
EHR Intelligence

Brianne Spellane, Senior Director, Communications and Content Strategy
It’s Not Just the Uninsured — It’s Also the Cost of Health Care
Axios

Katie Oberkircher, Content Specialist, Market Intelligence & Insights
Tech Giants Pledge to Ease Patient, Provider Access to Health Data
The Wall Street Journal

 

Council Spotlight: Healthcare in Transition is a quick-read on the changing ACA landscape designed to help you navigate the many twists and turns moving forward. It includes timely information for you and your clients on issues shaping the future of healthcare. Please refer to ciab.com for the latest news on healthcare reform efforts. For more information or to provide any specific feedback, please contact Katie Oberkircher at katie.oberkircher@ciab.com.