How the farm bill could erode part of the Affordable Care Act
Provision may provide less comprehensive health care to farmers
WASHINGTON – Some Republican lawmakers continue to try to work around the federal health law’s requirements. That strategy can crop up in surprising places. Like the farm bill.
Tucked deep in the House version of the massive bill – amid crop subsidies and food assistance programs – is a provision that supporters say could help provide farmers with cheaper, but likely less comprehensive, health insurance than plans offered through the Affordable Care Act.
It calls for $65 million in loans and grants administered by the Department of Agriculture to help organizations establish agricultural-related “association” type health plans.
But the idea is not without skeptics.
“I don’t know that anyone at the Department of Agriculture, with all due respect, knows a darn thing about starting and maintaining a successful insurance company,” said Sabrina Corlette, a professor and project director at the Georgetown University Health Policy Institute.
Association health plans are offered through organizations whose members usually share a professional, employment, trade or other relationship, although the Trump administration is soon to finalize new rules widely expected to broaden eligibility while loosening the rules on benefits these plans must include. A combine harvester collects barley in 2016.
Under that proposal, association plans would not have to offer coverage across 10 broad “essential” categories of care, including hospitalization, prescription drugs and emergency care. They could also spend less premium revenue on medical care.
Under the farm bill, the secretary of Agriculture could grant up to 10 loans of no more than $15 million each, starting next year, to existing associations whose members are ranchers, farmers or other agribusinesses.
The language is strikingly similar to a bill introduced April 12 by Rep. Jeff Fortenberry, R-neb., a supporter of association health plans. He did not respond to calls for comment.
Although the farm bill is usually considered “mustpass” by many lawmakers, it is currently facing pushback because of controversy surrounding other parts of the measure, mainly language that would add additional work requirements to the food stamp program.
Still, the focus on association
health plans won’t go away.
The plans – coupled with another Trump administration move to make short-term insurance more widely available – could draw healthier people out of the ACA markets, leaving the pool of beneficiaries with higher percentages of people who need medical care. And that, some say, could drive up premiums for those who remain.
The National Association of Insurance Commissioners, for example, has warned that association plans “threaten the stability of the small group market” and “provide inadequate benefits and insufficient protection to consumers.”
Actuaries have made similar arguments.
Others are concerned about the idea of the government providing funding for such plans.
“We have reams of experience with AHPS that have gone belly up ... and the notion that we should put taxpayer money into them is irresponsible,” said Georgetown University’s Corlette.
She was referring to the industry’s mixed track record with plans. Some have served members well, but other plans have been marked by solvency problems that left consumers on the hook with unpaid medical bills or were investigated for providing little or no coverage for such things as chemotherapy or doctor office visits.
It’s not fair to simply focus on the failures, countered attorney Christopher Condeluci, who served as tax and benefits counsel to the Senate Finance Committee and now advises private clients, some of whom are interested in association plans.
“Some AHPS were not successful,” he agreed. “But there’s arguably more examples of AHPS that work. The trouble is everyone focuses on the negative.”
Although the GOP generally supports association plans, using taxpayer funds to help start them could prove problematic for some conservatives in Congress.