Tuesday, March 13, 2018

Killing the ACA in a Short Term

Remember Tom Price, the orthopedic surgeon/Secretary of Health and Human Services, who wanted to rip the heart out of the Affordable Care Act (ACA) but instead was sent packing after racking up at least $400,000 taking private jets for short flights (eg. DC to Philadelphia)?

Well, you may not have paid much attention to his replacement, Alex Azar, but we all should.  He's a bit more complicated than his predecessor.  He was the Deputy HHS Secretary under George Bush, followed by a stint as President of the US division of Eli Lilly, a giant drug company. For better or worse, he has far deeper knowledge of the health care system than the bone carpenter from Oklahoma.  And he could be far worse. 

He is an abortion opponent, has a history of vocal opposition to the Affordable Care Act, and he's allowing states to impose work requirements on Medicaid recipients.

But so far he's enforcing the regulations, including those introduced under Obama.  The latest example was his rejection of Idaho's outright illegal and jug headed decision to simply ignore the ACA requirements.  Under Governor Otter, Idaho insurers could sell plans without its essential benefits, notably maternity care and vision and dental for kids. These plans would have deductibles in the thousands of dollars and cap annual benefits at $1 million—also not allowed under the ACA. Premiums for older adults compared to younger one would increase significantly.  And for people with pre-existing conditions, premiums would go up by 50%; in fact, these individuals wouldn't get any coverage at all for a year if they had been uninsured for 63 days.

Blue Cross of Idaho called these "Freedom Blue"plans.   Question, why does "Freedom" for Republicans generally involve the rich being free to take anything they want and the poor being free of basic rights and necessities?    

But, although Azar did a good thing in blocking Governor Otter's plan and therefore other state governments from adopting similar ones, he has proposed a nefarious play that could undermine ACA's entire foundation—the extension of short term plans.  

These plans are currently allowed under the ACA as temporary insurance for people who need it but have missed the open enrollment period for coverage under the health exchanges. They are intended to provide insurance for three months at most and they don't need to cover the following:
  • ·      Pre-existing conditions, including chronic pain.
  • ·      Essential benefits
  • ·      Preventive care
  • ·      Prescription drugs outside the hospital

The short-term plans can’t be renewed or used as full-time coverage without paying a penalty.  They are only intended to fill the gap until a person can be covered under a full ACA-compliant insurance package. 


Well, no surprise, the Trump administration has been salivating over these weak but legal plans, and Azar now intends to Frankenstein them into year-long and renewable Monsters. (Several insurers have already sidestepped the rule by packaging consecutive 90-day plans, with a one-time review of a patient's medical history.) Thus, these plans, originally created to be a temporary aid, will become the Republican's grotesque tools for stomping on the ACA's critical benefits, weakening the market for healthy people and increasing premiums, including dramatically for those with pre-existing conditions. Once again we become vulnerable to the exorbitant costs of our obscene medical system.

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