Trump administration loosens restrictions on ObamaCare waivers

[fleur-de-lisa]

Source: The Hill

A new guidance issued Monday by the Trump administration loosens restrictions states face to waive ObamaCare requirements and will allow them to pursue conservative health policies that were previously not allowed under the Obama administration.

Currently, states can apply for waivers from certain ObamaCare policies in order to help shore up individual insurance markets. The waivers were designed with specific “guardrails” meant to ensure that the waivers met at least the same coverage level as under ObamaCare.

The new guidance loosens those restrictions and allows states to promote health plans that don’t require the same level of coverage as the federal health law, including charging higher premiums for people with pre-existing conditions.
The guidance is a boon for red states that were previously denied ObamaCare waivers because they would not have provided sufficient coverage.

Now, those states will be allowed to offer plans with much less comprehensive coverage in what critics have called a “parallel” insurance market. Experts say that market will be more attractive to younger, healthier people.

Read more: https://thehill.com/policy/healthcare/412543-trump-administration-loosens-restrictions-on-obamacare-waivers

[SHRED]

1. Junk plans here we go again

[turbinetree]

2. This says everything about this traitor...........where he tries to make a buck on BS

[iluvtennis]

3. ..."including charging higher premiums for people with pre-existing conditions" - this is why we

still need ObamaCare. Trump goes to his rallies and tells his base GOP will not take away coverage for folks with pre-existing conditions, but fails to mention, they will have to pay more for the coverage. LIAR.

[Honeycombe8]

5. These policies they are speaking of are not ACA policies. No one has to buy them.

People can still buy individual ACA policies and get the subsidy.

There really is a need for this. This is one of the things I've complained about regarding the ACA. It's very unfair to a group of people. I suppose the ACA could have been fixed to make it more fair, but since Trump "won," we don't have that option. But there really is a need for this for SOME people.

[Igel]

7. It still is ObamaCare.

That was the problem with the ACA. It was long, cumbersome, and very underdeveloped. It left a lot of things at executive discretion because it would have been bigger and more contentious--and that allowed the Obama administration to implement things that might not have been acceptable as part of the legislation. The law didn't fund some things (because it was necessary to keep it no more expensive than the projected increase built into the budget assumptions).

The ability to extend these waivers is apparently part of the ACA. Like not having funding for insurance company reimbursements. And allowing all kinds of other things.

The assumption was that nobody would ever do bad things or misuse these bits of administrative discretion. It was a (D) victory, and the future was (D) with no interruption, because now that the good guys had won who'd go back to the bad guys?

And, yes, a lot of times when laws with these kinds of loopholes were passed, or when there was an administrative requirement put in place, it was always pointed out that they could be reversed.

I rather assume that the (T) administration has a person whose job, at least half-time, is to read and re-read the ACA, HCRA, and the various regulations from the Obama administration to see what, exactly, can be done to achieve their goals then run the ideas up the flagpole.

[Honeycombe8]

4. This hurts the ACA, I guess, but helps people.

Particularly people who don't need coverage for a pre-existing condition (either they don't have one, or don't need ins. for one...like arthritis, which often doesn't require any medical treatment).

There is a group of people in the country, generally older and healthy, who can't get insurance or have to buy ins. from only one available company, and have trouble because it's so expensive and has a very narrow list of providers. So these people really were painted into a corner and have a real problem. In some areas, there are no ACA providers at all.

So this helps those people, and that's good. It's always good to help people be able to get health care that they want and can afford. I'm not sure of the effect on the ACA, but it's not good, I guess. OTOH, these people buying the new policies won't be using taxpayer dollars for subsidies, so the money saved from that could be used for the ACA in other ways, I would think. It would have been better if the ACA could have been fixed to help this group of people, but we don't have that option at this time.

[Ms. Toad]

9. This is not good. Period.

The only reason that the ACA has a prayer of maintaining affordable premiums is if the pool includes everyone. Anything which sucks off healthy individuals raises the price for the full service insurance.

If you really have no pre-existing conditions, buy the temporary plans that are already/still on the market - there are tons of them out there. They are pretty darn cheap, and many have decent coverage that falls short of meeting the ACA standards. Don't dilute the full coverage market by removing the relatively healthy population from it.

You'll have to shift plans every 6-18 months, but it's manageable. I used them for more than 2 years. My sister has also used them. Both of us have pre-existing conditions - so the plans did not cover those conditions, but they did cover everything else. Aside from penalties for not having insurance, which Trump has said he's not enforcing, there is no reason for anyone without pre-existing conditions to complain that they have no options.

In Nodaway County, Missouri - for example - (an area that does not have an ACA plan), thre are 50 plans available. You can obtain a short term insurance plan for $156.12 a month that has a $2500 deductible, 20% coinsurance, allows for 6 visits prior to the deductible being met (3 primary, 3 specialists) at a $30 copay.

Explore a bit, if you don't believe me. https://www.ehealthinsurance.com/short-term-health-insurance/find-coverage (One of several search tools available for short-term insurance)

Trump wants to bring these plans into the mainstream, make them available on a non-short term basis, and drain people from the ACA for the purpose of destroying it.

[Honeycombe8]

12. I read your first sentence and stopped there.

I don't want to argue. But your first sentence shows that you don't know the situation of everyone. You said, "The only reason that the ACA has a prayer of maintaining affordable premiums....."

The thing is...the ACA does not have "affordable premiums" for everyone.

For a middle class older person, premiums are unaffordable. Mine start at over $900/month...for bad coverage: HMO, $4,500 deductible, small provider lists, narrow drug lists, only 2 ins. cos. (and the other one is more expensive than the $900/mo.).

That's the group of people I'm speaking of. I'm transitioning into Medicare soon, so the ACA no longer will affect me soon.

But the ACA does not provide "affordable insurance" for everyone.

The ACA allows insurance companies to charge an older person TRIPLE RATES, even when they are healthy.

Here's a factoid: At one time, I was paying over $800/mo. for lousy insurance (I couldn't find a doctor to take it, because it was one of the low level metal plans), while someone I knew who was younger and unhealthy and worked less than I did was able to afford SILVER or GOLD level great plan.

The government was charging triple rates to people like me, so that other people could get not just the same coverage as I got, but BETTER coverage than I could possibly afford, at a fraction of the cost. AND they used it a lot. (I, OTOH, didn't use the ACA at all for years. I couldn't find a nearby doctor to take my low level plan, but I was in excellent health, so not a problem.)

Something was out of whack. It would have been great, if the ACA had been fixed to prevent that unfairness. For instance, the rule that let the ins. cos. charge older people triple rates could have been rolled back entirely, or even back to just double rates.

[Ms. Toad]

17. Reading what I actually wrote would be a good first step.

Not stopping at the first sentence would be a second.

I never claimed it was truly affordable for everyone. But destroying the premise (everyone in the pool) that has any hope of making that possible is lunacy - it will put us right back in the position we were in before ACA, when insurance was only available for healty people..

Your main contention was that it woudl be good for older older individuals without pre-exisitng conditions. Those individual already have options. Since you are reciting premiums in the range of $900, you obviously did not even visit the site that I directed you to that offers premiums well below that for healthy people of all ages.

Trump is trying to replace the ACA with these plans - that already exist - that are ONLY suitable for people without pre-existing conditions.

[Honeycombe8]

23. Respectfully, when you start out by saying that the ACA had affordable premiums...

I knew you didn't know about millions of ACA policies that were not "affordable." And they didn't provide great coverage, either.

Those older middle class Americans were hit with triple rates for policies with $6,500 deductibles, 30% coinsurance, skinny provider lists, and other restrictions. This was a true hardship for many.

Insurance companies were pulling out, co-ops were folding, ins. cos. were gaming the system, people couldn't find doctors to take the policies. The ACA was in serious trouble, and still is. It could have been fixed, but frankly, I didn't see any acknowledgement on the part of the Democratic leaders to address the problems head on. Or even acknowledge most of the problems.

The ACA worked great for a segment of the population. But it did not work great for another. This was all reported. Insurance companies were even being sued. It wasn't working, except for that segment for which it worked, which everyone acknowledged. But that's not the only segment in the country. You can be happy for those for whom it worked, but still acknowledge that it's not working for others.

It was a great idea, and it could work, if revised, I think. But I think Trump will dismantle it such that it will be a shell of what it was, before all this is over.

Even if we went to Medicare for all, that wouldn't be the panacea some think it would be. Only basic hospital coverage is provided in Medicare. Everything else costs the insured. No one has to pay triple rates because of his age, regardless of health, either. That would be grossly unfair.

[sakabatou]

6. Costs more to give you less

[Guppy]

8. I recently priced these out.

Golden Rule is one of the companies through United healthcare. They are short term. They have preexisting conditions and a maximum payout of $250,000. They are complete junk. My wife's cobra expired so I had to get insurance. I went to the exchange and got a policy. It is not very good but it does cover preexisting and there is no maximum.

[Ms. Toad]

10. They're not complete junk

I've used them when I was unable to obtain coverage pre-ACA because of a pre-existing condition that did not require treatment, but I could not afford to risk a new, unknown, disaster. My sister has also used them more recently - as have a few of my students who otherwise could not afford to take time off to study for the bar exam because they would lose insurance (or after the bar exam before they get a job that includes insurance).

You are correct that the plans do NOT cover pre-existing conditions - but they cover everything else -and, unlike Golden Rule which rejected covering me entirely in the days before the ACA, these plans take all comers and only exclude coverage of the condition - not the person. If you shop around, you can find policies that have much higher payouts, and even some that cover office visits before reaching the deductible. The deductibles vary considerably - I've seen as low as $500, and as high as several thousand.

So don't trash the plans merely becasue they are not full service plans. They were never meant to be. They are an invaluable tool to fill a few month's gap between employment-based coverage, for when you miss the open enrollment sign up period (either ACA or work), or are terminated and COBRA is too expensive.

They should NOT however be permitted to be treated as ACA plans, which is what Trump is trying to do. He wants to draw people from the ACA market into plans that do not offer full coverage because they are more affordable to people who are temporarily without pre-existing conditions. He intends to use them to draw people away from the ACA market place with the express purpose of destroying it by driving the premiums up.

[Guppy]

11. the issue is the 250k payout

and you can get ACA. There is a special exemption for exactly things like losing cobra. If you have a heart attack on one of these you will be bankrupt. The two things the ACA did was preexisting conditions and no cap.

[Ms. Toad]

16. I'm not suggesting that these are equivalent to the ACA

I am countering the suggestion they are junk.

I have personally helped a number of people who are not eligible for the ACA plans find some coverage when there were no other alternatives. Both my sister and I have also used these plans as our primary plans when we had no alternatives - before the ACA in my case, and after for my sister.

Losing COBRA creates a special open enrollment period. Losing your job does. Getting married does. But not everything does. Missing the deadlne for open enrollment at work or through the ACA doesn't, for example. Even though these plans are not ACA plans, they are better than nothing when your choice is between a plan like this and nothing. And - short of truly catastrophic and costly pre-existing conditions - any of them are very economical plans that offer decent emergency coverage for generally healthy people.

As for your suggestion that the ACA did two things, it actually did at least 3 things:

No people exclusions
No pre-existing conditions exclusions
No cap.

These short term plans address the exclusions on people. Prior to the ACA, even if you were willing to waive coverage for the pre-existing condition the plan could reject you entirely (not just coverage of your pre-existing condition). Believe me - I was rejected by enough plans to now the problem. I had a relatively innocuous previous condition for which Golden Rule rejected me (after a prior plan had accepted me, so it caught me off guard). That rejection left me completely uninsurable. (The top question on any health insurance application prior to the ACA was whether you had previously been rejected for coverage.) I agreed to waive coverage for that condition - repeatedly - and not a single insurance company was willing to cover me. The short term policies were - and since I really only needed coverage in the case of a catastrophic event, short of being able to have real insurane, they were perfect. I covered myself for around 2 years at a total cost of no more than $300.

As ot the cap on coverage - some of the plans are not capped at 250K. Most in my area are capped at $1 million or $2 million. $750,000 is the lowest.

[Honeycombe8]

14. I don't think the law is aimed at short term plans. I think they're aimed at regular coverage.

It doesn't say, but there are short term plans already in existence. I think they're trying to encourage regular insurance coming back to the markets.

Short term and regular insurance are for two different purposes entirely.

I had a short term policy once to bridge a gap between insurance coverage. It was a lot less than COBRA, and while not comparable to regular insurance, it did provide security against something serious, at lower cost. I had a $1M cap, high deductible.

[Ms. Toad]

18. And Trump is trying to make these short term plans

a substitute for the ACA.

You are right - they are not the same - which is my problem with what he is trying to do. The short term plans already exist - no need to entice them back into the market, and there are very good reasons (like the destruction of the ACA) to prohibit them being used as a substitute for the ACA plans.

[Honeycombe8]

13. Golden Rule is short term policy coverage, I believe.

I believe what the OP law is related to is addressing regular insurance.

I've had short term coverage before between jobs. It's great for that purpose. Low cost. It's basically for a semi-catastrophic event. Mine had a $1Million Dollar cap. High deductible. But I could get a flu shot, a dr visit for sinus trouble or whatever. It had a decent provider list.

If you have short term coverage, and get cancer, Golden Rule won't renew you, but you could join the ACA during the enrollment period. Generally, tho, short term coverage is used by healthy people to cover a gap in employment. Even when you start work, there is sometimes 30 days before ins. kicks in.

[Ms. Toad]

19. The exact same thing will happen with what Trump is proposing

Get sick - and the plan won't renew you. Anything Trump suggests to the contrary is just smoke and mirrors. There is no free ride. And when you have that catastrophic condition, when you try to enroll in the ACA, the premium will be $1500/month, with a $12,500 deductible - as the only plan in Ohio that accepted anyone with preconditions was before the ACA. Oh, wait, that was for my 18 year old daughter. As someone approaching retirement it will be more like $4,500/month.

You can't take healthy people out of the pool and have insurance premiums that anyone who actually needs insurance can afford.

[Honeycombe8]

15. Golden Rule short term plans have various caps. In my area, they go up to $2M.

Short term plans are good for bridging a gap in coverage. They are not intended to replace regular insurance, which is what I think the new law is aimed at (getting regular long term policies on the market).

[Ms. Toad]

20. No. The new policy (not law)

Last edited Mon Oct 22, 2018, 08:50 PM - Edit history (1)

is aimed at allowing these short term plans to be used as substitutes for the ACA. He is not changing the essential nature of those plans.

The second expands the three-month short term plans under the law, intended for people who need stop-gap, skimpy coverage as a bridge, to be continued for as long as three years.

https://www.dailykos.com/stories/2018/10/22/1806366/-Latest-move-from-Trump-proves-Republicans-don-t-care-about-your-health-care

[Honeycombe8]

21. But that's a good thing...to expand coverage from a few months to several years.

If I understand what the law is seeking to do.

I did not find my short term coverage "skimpy" in the sense that someone else might. I did not need maternity coverage, drug rehab, mental health coverage, and such. It provided pretty much the standard stuff...hospital, ER, doctor visits, copays, a decent provider list. I did find that the drug list was very skimpy. Very. I don't think it had the main cancer drugs, for example. But that may have been only the plan I selected (I didn't take medication, so didn't care about that).

But if those cos. want to sell long term policies, they will have to make them more normal, in order for them to sell. Of course the pre-existing condition thing is "yuge." For the short term policies, I knew they wouldn't renew, if I used it for something significant. But for a regular policy, pre-existing conditions MUST be covered.

Compare that with the ACA policies I've had. Just for my area, mind you. I essentially lost health care, when the ACA was enacted. I could not find a doctor in my local area (within 10 miles) to take my policy. The first year, there were no cancer doctors on the provider list (so I did not have cancer coverage).

As time went on, the insurance companies started narrowing their provider lists more and more, as an intentional way to reduce claims. The result was that I did not go to the doctor at all from 2014 until an exam in 2017. But the insurance company was paid over $36,000 for my coverage for 2014 thru 2017. The ins. co. would have rec'd $12,000 for that same policy from someone who used it a lot, but was younger.

The ACA just did not work for me, and I would think, others in my age group and situation. It could have been fixed, IMO. But as you can see, it was hard to get anyone to listen. It worked well for most, but not great for everyone. If I hadn't qualified for a subsidy, I would not have been able to get it at all. It was too expensive. $1,000/mo. for a bronze level HMO with a $4,500 deductible. Wow. At least when I moved I found a couple of doctors who would take it in my location, so I was able to get my first exam since 2013. And I'm still healthy, thank goodness!

[Ms. Toad]

22. You can already do that just by stringing multiple policies together

The policies Trump is authorizing will not cover pre-existing conditions. They are literally just extensions of the short term policies. He is not requiring them to be "more normal."

There is NO need to permit states to create longer short-term policies as an alternative to the ACA to make it easier for people to avoid being part of the entire insurance pool.

As far as getting anyone to listen - we were too busy trying to survive - which requires the survival of the ACA. We can't fix it until people- from both parties - stop attacking it. Let the market stabilize, and then we can work on fixing it. The only reason it took so long to start stabilizing (which it finally started to do this year) was because there was lawsuit after lawsuit, followed by repeal attempt by repeal attempt, and theft of the money set aside to subsidize coverage (meaning insurance companies were obligated to cover people without the subsidy money that made it possible). Insurance companies need stability, so they can evaluate the risks. Rather than bringing companies back into the market, this will further destabilize it.

My daughter has been fighting for her life since she was 4 years old. She's now 27 has yet to finish college, makes $14,000/year, and has $200,000 in medical bills each and every year - and every attack on the ACA - regardless of the party that makes it - is an attack on her life. She literally cannnot survive without the ACA (absent a move to single payer, which just isn't politically realistic).

The inconvenience to you of stringing to gether multiple short term policies, rather than buying one longer one that gives you precisely the same benefits, with preciselty the same limitations, kinda pales in comparison. Stop falling for his smoke and mirrors - he lies about literally everything else. Why on earth would you believe him here?

[ck4829]

24. Kick