The new final rule on short-term, limited-duration (STLD) plans covered in our Aug. 13 issue has drawn praise from Republicans, their supporters and people who sell STLD insurance; everyone else's opinion ranges from diffident to hostile.
HHS Secretary Alex Azar cheered, “President Trump is bringing more affordable insurance options back to the market, including through allowing the renewal of short-term plans. These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.” Other GOP office-holders backed him up: "We believe building a strong insurance market requires giving people as many affordable options as possible, not just Washington-dictated plans,” said Oklahoma’s Republican insurance commissioner, John D. Doak. “Short-term, limited-duration insurance is another step in the right direction."
Media outlets were negative – “Trump Administration Aims to Steer People Toward Junk Health Plans Over Obamacare,” said New York magazine – or positive – “Americans are 'winning' on health care as Trump administration chips away at ObamaCare," said Fox News – depending on political orientation.
As analyst Katie Keith notes in the August 1 Health Affairs, insurance companies and groups had favored the three-month non-renewable standard the Obama administration had established in a 2016 rule and are expectedly less than enthusiastic about the new standard. While "the new requirement for short-term plans to make clearer disclosures to consumers is an important improvement," said America’s Health Insurance Plans (AHIP) president and CEO Matt Eyles, AHIP "remains concerned that consumers who rely on short-term plans for an extended time period will face high medical bills when they need care that isn’t covered or exceed their coverage limits."
"The broader availability and longer duration of slimmed-down policies that do not provide comprehensive coverage has the potential to harm consumers,” added the Blue Cross Blue Shield Association.
The American Academy of Actuaries expects the new standard “will likely contribute to premium increases in Affordable Care Act (ACA) individual markets, while creating new insurance options for some consumers that provide fewer benefits at lower premiums than ACA-compliant plans.” The group warns that STLD plans have none of the benefits of ACA plans – including premium and cost-sharing subsidies – and that, depending on interpretation of the regulation, when beneficiaries reapply for coverage each year, their “pre-existing condition exclusions could begin again upon reapplication. That is, conditions acquired during the initial benefit period could be excluded in the next benefit period.”
The American Medical Association has been quiet on the final rule so far, though in April it joined many other medical organizations, patient groups and medical advocacy groups like the Kaiser Family Foundation in criticizing the proposed rule, saying it would promote “substandard, inadequate health insurance coverage.” The American Heart Association is “deeply troubled” by the final rule, which it believes will “reintroduce health insurance discrimination based on gender, health status, age and pre-existing conditions” and may “exacerbate the affordability concerns for unsubsidized individuals even as many states are implementing reinsurance programs to lower cost.”
The CEO of a company that offers STLD plans made perhaps the most eloquent defense of them: "It's a way better alternative to not being insured," Jeff Smedsrud of Pivot Health told WCJB in Gainesville, Florida.