{"id":63968,"date":"2018-07-22T15:23:48","date_gmt":"2018-07-22T21:23:48","guid":{"rendered":"https:\/\/dh.durangoherald.com\/tj\/resurrecting-old-insurance-model-may-limit-coverage\/"},"modified":"2018-07-22T21:23:48","modified_gmt":"2018-07-22T21:23:48","slug":"resurrecting-old-insurance-model-may-limit-coverage","status":"publish","type":"post","link":"https:\/\/dh.durangoherald.com\/tj\/resurrecting-old-insurance-model-may-limit-coverage\/","title":{"rendered":"Resurrecting old insurance model may limit coverage"},"content":{"rendered":"
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du1-i-syn<\/span><\/figcaption><\/figure>\n

Obamacare policies sold in the so-called individual market. That\u2019s the place where people who don\u2019t have employer or government-sponsored insurance turn when they need coverage.<\/p>\n

It\u2019s no secret that rising premiums have hurt people in that market if they are among those whom the law considers too wealthy for subsidies to help them out \u2013 for example, families of four with incomes above $100,400 and single people whose incomes exceed $48,560.<\/p>\n

So President Donald Trump\u2019s administration has approved the return of association policies, called AHPs for short.<\/p>\n

Fraternal or professional organizations can sponsor one. A single proprietor or sole owner of a business can also set up one of these new arrangements.<\/p>\n

But these \u201cnew\u201d arrangements are not new. They were around for years before the Affordable Care Act was passed, and they\u2019ve been resurrected by the Trump administration to promote a low-cost option for a small slice of the insurance marketplace.<\/p>\n

Labor Secretary Alexander Acosta offers this rationale: \u201cMany of our laws, particularly Obamacare, make health care more expensive for small businesses than large companies. AHPs are about more choice, more access and more coverage.\u201d<\/p>\n

Once again, the individual market may become the Wild, Wild West of insurance as sellers pick and choose what benefits to offer. They can present a shopping nightmare for consumers who try to slog through the market and understand what they\u2019re buying.<\/p>\n

Many of the protections offered by the ACA are gone, and shoppers are on their own to sort through the fine print that may or may not disclose what they are buying. For example, the Affordable Care Act outlawed the practice of considering a person\u2019s pre-existing health conditions before issuing a policy, one of the most important protections it provided.<\/p>\n

Under the government\u2019s rules for AHPs, a person\u2019s health still cannot be factored into the decision to issue a policy. But insurers may find a way around this limitation, says Sabrina Corlette, a research professor at Georgetown University\u2019s Center for Health Insurance Reforms.<\/p>\n

\u201cThe way benefits are designed can make a policy very unattractive to certain groups of sick people,\u201d she told me.<\/p>\n

If an insurance group doesn\u2019t want to cover a lot of people with HIV-AIDS, it could create a network that includes almost no doctors who treat people with that condition.<\/p>\n

AHPs must still cover the ACA\u2019s preventive services like mammograms and diabetes screening. But other ACA protections are gone.<\/p>\n

Fewer benefits and ones that are less comprehensive are the trade-offs for cheaper policies.<\/p>\n

\u201cAHPs will have more flexibility in how they vary premiums and what benefits are covered,\u201d says Cori Uccello, senior health fellow at the American Academy of Actuaries.<\/p>\n

Here\u2019s where the shopping task gets tricky. AHPs won\u2019t be required to cover any of the ACA\u2019s package of essential benefits \u2013 things like mental health, maternity, and prescription drugs. It\u2019s also possible their benefits could come with limitations on hospital stays and doctor visits.<\/p>\n

Comparing policies with these different combinations of benefits will take some effort.<\/p>\n

There are other changes, too, that would-be shoppers should be aware of. The \u201cflexibility\u201d touted by the Labor Secretary means that AHPs will now be able to use gender in deciding how much to charge. Women could be forced to pay more than men because insurers say that, especially at younger ages, women have more claims.<\/p>\n

On the Health Affairs blog, Katie Keith of Keith Health Policy Solutions showed what could happen when gender is factored into the pricing decision. Keith pointed to a Blue Cross Blue Shield comment letter that suggested AHPs could rate (determine what to charge) young men more than 40 percent lower than insurers could while young women could be rated more than 30 percent higher.<\/p>\n

The AHPs could rate engineers nine percent lower than insurers and rate taxi drivers 15 percent higher. Engineers apparently file fewer claims than taxi drivers. That may be the biggest change \u2013 that AHPs will be able to consider people\u2019s jobs in the decision to insure them.<\/p>\n

The ACA had outlawed the practice of occupational underwriting, which had meant that waiters, musicians, models, beauty operators, fry cooks, even doctors and lawyers sometimes couldn\u2019t obtain insurance because insurance stats showed people in those occupations filed more claims.<\/p>\n

Will people in those occupations be turned down now?<\/p>\n

Association health plans might look like a panacea for the country\u2019s health care woes. But questionable practices are likely to resurface, and it\u2019s not clear state insurance departments, which had a tough time keeping tabs on fraud and abuse years ago, are up to the job of policing them. AHPs may well throw the individual market into a big mess without addressing the fundamental problem they purport to solve: the underlying high price of American medical care.<\/p>\n

What would you choose: lower premiums or skimpier benefits? Write to Trudy at trudy.lieberman@gmail.com<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

du1-i-syn Obamacare policies sold in the so-called individual market. That\u2019s the place where people who don\u2019t have employer or government-sponsored insurance turn when they need coverage. It\u2019s no secret that rising premiums have hurt people in that market if they are among those whom the law considers too wealthy for subsidies to help them out […]<\/p>\n","protected":false},"author":1,"featured_media":63969,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[61],"naviga_topic":[],"class_list":["post-63968","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-health"],"acf":[],"author_name":"dh_admin","_links":{"self":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/63968","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/comments?post=63968"}],"version-history":[{"count":0,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/63968\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/media\/63969"}],"wp:attachment":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/media?parent=63968"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/categories?post=63968"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/tags?post=63968"},{"taxonomy":"naviga_topic","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/naviga_topic?post=63968"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}