Trump health cov­er­age al­ter­na­tives may pose risk to the sick

South Florida Times - - HEALTH - By As­so­ci­ated Press But that’s true largely for cus­tomers with good health.

TOM MUR­PHY

The White House is work­ing on a plan that could bring more health in­sur­ance choices and cheaper op­tions to peo­ple buy­ing in­di­vid­ual and small busi­ness cov­er­age. But the bill for this might be paid by the sick.

Se­nior ad­min­is­tra­tion of­fi­cials have said Pres­i­dent Don­ald Trump is ex­pected sign an ex­ec­u­tive or­der this week to ex­pand the use of health plans of­fered through as­so­ci­a­tions. These groups al­ready al­low in­di­vid­u­als or busi­nesses to band to­gether to buy cov­er­age, and Trump’s or­der could in­crease their use by mak­ing it eas­ier to sell this cov­er­age across state lines. On Tues­day,Trump tweeted:“I will be us­ing the power of the pen to give great Health­Care to many peo­ple — FAST.” Specifics of the or­der and any re­sult­ing reg­u­la­tion are still not clear.This cov­er­age could wind up cost­ing some shop­pers less if the poli­cies don’t have to meet the cov­er­age re­quire­ments of in­di­vid­ual states or the Af­ford­able Care Act.

A LOOK AT HOW THE MARKET MIGHT CHANGE.

Q:What’s the sit­u­a­tion now? A: Health in­sur­ance in the United States falls un­der a patch­work of reg­u­la­tions. States over­see in­di­vid­ual in­sur­ance and most small busi­ness plans, as well as cov­er­age of­fered through as­so­ci­a­tions. Health in­sur­ance pro­vided by large em­ploy­ers is reg­u­lated by the fed­eral gov­ern­ment, a distinc­tion that ex­isted long be­fore the Af­ford­able Care Act be­came law.

State-reg­u­lated plans must meet cov­er­age re­quire­ments of that state as well as those of the ACA, all of which can add to the price. The ACA re­quires cov­er­age of broad ben­e­fits cat­e­gories like ma­ter­nity care, pre­scrip­tion drugs and men­tal health ser­vices. States can in­sist on other things, like in­fer­til­ity treat­ments. Q:What might hap­pen? A: If the White House lets state-reg­u­lated groups fall un­der fed­eral reg­u­la­tion, a lot could change. In­sur­ance of­fered through an as­so­ci­a­tion could set prices based on a cus­tomer’s health, which can’t hap­pen now. It could ex­clude po­ten­tially ex­pen­sive ben­e­fits like pre­scrip­tion drug cov­er­age to knock down the pre­mium or price for cov­er­age.

Fed­eral reg­u­la­tion also would make it eas­ier for as­so­ci­a­tions to of­fer cov­er­age in sev­eral states, which would in­crease choice.The White House also might loosen re­stric­tions on short-term in­sur­ance plans that gen­er­ally have lim­ited ben­e­fits and re­main in force for less than a year.

The main theme be­hind these ideas is dereg­u­lat­ing health in­sur­ance, said Sab­rina Cor­lette, a pro­fes­sor at Ge­orge­town’s Cen­ter on Health In­sur­ance Re­forms. Q:Who does this help and hurt? A: Peo­ple who rarely need a doc­tor and take no reg­u­lar med­i­ca­tions might find cheaper op­tions tai­lored more to their needs. They wouldn’t have to buy in­sur­ance loaded with cov­er­age they don’t use.The same goes for a small busi­ness with mostly young, healthy em­ploy­ees.

How­ever, this op­tion could upset a del­i­cate bal­ance needed to con­trol prices. In­sur­ers de­pend on the money they col­lect from healthy cus­tomers to counter claims they pay for the sick.With­out those healthy cus­tomers, the cost might rise faster for peo­ple with med­i­cal con­di­tions.

Small busi­nesses with an older or less healthy work­force also may have to pay more. If, for in­stance, a bunch of dry clean­ers buy cov­er­age through an as­so­ci­a­tion, the in­surer may set sep­a­rate prices for each based on em­ployee health, noted Kevin Lu­cia, an­other Ge­orge­town pro­fes­sor.

Con­sumer pro­tec­tion also may suf­fer. Fed­eral reg­u­la­tors gen­er­ally have fewer re­sources for in­ves­ti­gat­ing com­plaints or help­ing con­sumers than their state coun­ter­parts, said Mila Kof­man, ex­ec­u­tive direc­tor of the D.C. Health Ben­e­fit Ex­change.

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