Some Democratic lawmakers worry that continued reform of Medicaid could lead to increased enrollment in short-term health insurance as Americans begin to shift from safety net coverage to other insurance options.
Although this is a legitimate concern, insurance experts say, given the availability of more comprehensive and affordable plans in the Affordable Care Act market, it shouldn't be much of a problem.
However, the Biden administration must still work to curtail short-term, time-limited plans that fail to protect people with pre-existing medical conditions, routinely deny claims based on health conditions, retroactively cancel coverage of participants and result in exorbitant bills. sudden. in a narrow throat. network operator says.
Right now, about half of US states have banned or limited short-term plans.
"Some of the marketing for short-term plans can be misleading," said Matt Fiedler, senior health policy researcher for the USC-Brookings Schaeffer Initiative. "The concern is that when they leave Medicaid, there are people who are supposed to be in the market, who are instead being dragged into the market in the short term."
ACA plans offer a cheaper, more comprehensive option
One of the Trump administration's most controversial public health moves has been to expand short-term plans and open them to all consumers. Originally designed as a low-cost safety net coverage for only three months, the plans are not required to cover 10 essential healthcare services under the ACA.
After the expansion, the number of plan enrollees jumped to nearly 3 million in 2019, according to a study by Maison.
President Joe Biden has condemned the show, but his administration has not yet repealed the Trump-era rule.
Earlier this month, the Democratic leaders of the House Energy and Commerce Committee sent a letter to the HHS, Labor and Treasury departments asking them to pull the short-term, time-bound plans before the end of continuous enrollment. Medicaid, which affects millions of people. from the public. Consumers can be drawn into the "junk" wrapper.
Medicaid eligibility checks were suspended during the COVID-19 public health emergency, expanding the program to more than 80 million Americans. However, continued coverage ends March 31, when states can appeal eligibility regulations.
About 18 million people are expected to lose Medicaid insurance, according to the Urban Institute. Of those, more than 1 million will sign up for the out-of-group market, including those created by the ACA. There will be no insurance for about 3.8 million people.
This is the demographic at risk of abandoning short-term plans. Given the lack of comprehensive data on short-term dietary intake at this time, the researchers said, it is difficult to gauge the scale of the problem.
As other health insurers scramble to recruit new members, operators of short-term plans will ramp up marketing starting in April to target those who buy health insurance during the Medicaid crisis.
Experts say deceptive marketing tactics and consumers unsure of their insurance choices can lead more people to purchase insurance coverage that isn't right for them.
Non-ACA plans have a documented history of deceptive marketing. Salespeople often misrepresent consumers' insurance coverage, deceive them into purchasing plans over the phone without proper information, or fail to disclose important coverage limitations, including exclusions for pre-existing medical conditions.
"Unfortunately, a lot of this marketing is missing the ball in terms of actual coverage in short-term plans and what is and isn't covered," said Sabrina Corlett, director of the Correction Center. Georgetown University Health Insurance.
Deceptive marketing can present short-term plans as cheaper than alternative options, including ACA coverage, which can entice cost-conscious Americans to opt for coverage.
More Americans now enjoy backed market coverage on ACA exchanges thanks to the COVID-19 funding relief, which Congress recently extended through 2025.
Now, people with incomes over 400% of the federal poverty line qualify for benefits, and those with lower incomes get more financial assistance. For example, people whose income is less than 150% of the poverty line can get a plan with a monthly premium of $0.
As a result, short-term plans can cost hundreds of dollars more per month than market plans and have a much higher cost ratio. In a confidential survey of shoppers conducted by the Center for Health Insurance Reform, marketers recommended plans with monthly payments ranging from $70 to $300.
"I think short-term policies are going to be difficult to sell to agents in this market because of the cost to people on very low incomes," said Sarah Collins, head of health insurance at the Commonwealth Trust.
Another reason insurance professionals aren't worried about increasing enrollment in short-term plans is the open window for ACA enrollment during Medicaid reform.
One of the reasons people ask about historically poor coverage is because they missed the ACA plan's enrollment deadline and didn't have an enrollment-eligible event. out of the window.
That doesn't apply during the start of Medicaid, where the Biden administration has announced a special filing deadline that industry experts say states that run their own exchanges must meet.
"theoretical probability"
HHS said in its final regulatory agenda that it intends to come up with a proposal to expand short-term health plans by April. This timeline is not binding, the researchers said, and it is difficult to prioritize communications regulators.
In addition to the uncertainty about how many people are enrolled in the short-term plans, given the length of the rule-making process, it is unlikely to be completed by the end of the year, even if regulators are proposing new results now. However, health policy experts said HHS still needs to work to limit the availability of these plans to appeal to the segment of the market that leaves Americans without insurance.
It's also important for the Biden administration, state Medicaid and reimbursement agencies, experts say, to target marketing and consumer support efforts to people who have recently lost Medicaid coverage so they don't hesitate to market short-term plans.
CMS has been working with states for over a year to update affiliate contact details, strengthen its administrative staff, and implement deregistration support and beneficiary outreach strategies, including social and community campaigns.
"I would like to think that support for ACA plans would be broad and strong enough to sink bad plans," said Sarah Locke, vice president of health policy at the Center on Budget and Policy Priorities.
In states that don't limit sales to plans or expand Medicaid, the researchers said, consumers are more anxious if they unknowingly choose minimum coverage.
According to CHIR's Corlette, the 11 states that haven't expanded Medicaid, such as Florida and Texas, have more low-income citizens and fewer regulations, making them more amenable to insurance companies trying to skirt the rules and distort their offerings. .
But overall, concerns that Medicaid reform could cause many consumers to fall into plans are likely short-term.
“Is that a theoretical possibility? Yes. Is it likely to matter quantitatively?” I suspect the answer is probably no, but there is uncertainty about that, said Fiedler of the University of California, Brookings.
