Biden quietly healing wounded Obamacare

Slowly but surely, President Biden is repairing the U.S. health care system, reversing Trump-era sabotage and ensuring millions more Americans get access to affordable coverage.

The latest of these efforts came in a little-noticed but significant decision to protect Americans from junk health insurance.

In 2017, Congress repeatedly tried and failed to repeal the Affordable Care Act. To casual observers, it might have looked like the end of the Republican fight to kill this lifesaving, inequality-fighting, newly popular law. It wasn’t. Over the next few years, President Donald Trump found new ways to sabotage the health care system and its protections for the most vulnerable Americans.

Among the most insidious of these backdoor repeal measures: expanding “short-term, limited duration” health plans.

Short-term plans are theoretically intended as brief, stopgap coverage — say, to tide over a new college grad whose job doesn’t start until the fall.

They’re relatively unregulated; they don’t have to cover minimum care benefits guaranteed by Obamacare and other major legislation, for example. A 2018 analysis found that most don’t cover maternity services, substance-abuse care or prescription drugs.

These plans can also deny coverage for care of pre-existing conditions, even if the preexisting condition in question hadn’t yet been diagnosed at the time the person enrolled.

People often don’t realize they’ve bought a worthless product until it’s too late.

Such loopholes might seem like no big deal until you find yourself falling through one. The Trump administration made sure more people did by allowing these allegedly shortterm plans to last as long as

364 days, rather than the threemonth max that had been in place, and to be renewed for up to three years.

This made them look a whole lot like regular plans. Plus, because short-term plans are mega-profitable for insurers, brokers can get much larger commissions for steering hapless customers into them. So many did.

Exactly how many were lured by this policy change is unclear; the data is lousy, precisely because these products are so unregulated. A recent estimate from the Urban Institute ballparked the number of people enrolled in individual plans that are noncompliant with Obamacare protections at 2.5 million.

The proliferation of shortterm junk plans affects even consumers who don’t get duped by them. That’s because these cheaper plans disproportionately siphon healthier (i.e., lower-cost) people out of the broader individual insurance marketplaces. People who have chronic conditions or otherwise know they will need more substantial coverage are more likely to stay in the regular marketplace pool, driving premiums there ever higher.

Recently, however, the Biden administration announced a rollback of this Trump-era expansion of short-term health plans.

In a proposed rule, Biden officials said those already in these skimpy Trump-blessed plans can continue in them, if they so choose. But going forward, any new “short-term, limited duration” plans would need to be truly short term (up to three months) and truly limited duration (renewed for up to one additional month only).

Critically, short-term plans must also provide clearer language about what care they do and don’t cover, and under what circumstances.

The White House has marketed this rule as part of “Bidenomics,” though it might be more easily understood as simply pro-consumer. It also dovetails nicely with other actions the administration has taken to expand access to coverage, including outreach to encourage eligible Americans to enroll in marketplace plans and patching the so-called family glitch.

Most important, through last summer’s Inflation Reduction Act, Biden extended the enhanced premium tax credits available for plans on the individual marketplace.

This has meant that millions more Americans can get solid health care coverage that’s not only affordable but also, in many cases, has an out-ofpocket premium of zero dollars.

It’s not a bait-and-switch. It’s a real subsidy — and one that will likely drive down premiums overall, on average, by drawing more healthy people into the broader marketplace risk pool.

Our health-care system is still kludgy. It still allows too many Americans to fall through the cracks. But small unsung fixes such as this are achievements worth celebrating.