President Donald Trump and congressional Republicans have not yet killed the Affordable Care Act, but they certainly have reshaped it.
Nearly two years later, most parts of the law remain in place, although the Trump administration chipped away some of the law’s provisions.
Four of the most significant ACA changes that occurred in 2018 were:
Association Health Plans
Small companies and self-employed individuals are allowed to band together and buy health insurance outside of the ACA’s rules. Such plans are referred to as association health plans and can be sold across state lines.
This was the first major change to the ACA since Congress repealed the individual mandate penalty in the tax cut bill at the end of 2017.
The Congressional Budget Office estimates that 4 million people, including 400,000 who otherwise would go without insurance, are expected to join association health care plans by 2023.
The plans must keep same protections for sicker or older Americans as those that apply to large companies, yet they wouldn’t have to cover the full range of benefits mandated by the ACA, so coverage for things such as mental health or maternity care might be missing.
Health insurers are now allowed to sell short-term plans that last up to 364 days. Previously, those plans were limited to 90-day terms.
The plans are usually less expensive, but they often don’t cover the minimum set of benefits such as prescription drugs, mental health or maternity care that ACA plans must cover. These short-term plans can also exclude or limit coverage based on pre-existing medical conditions.
Easier Hardship Exemptions
It is now easier for consumers to claim a hardship exemption that relieves them of the requirement to have coverage.
Under the new rules, people can apply for a hardship exemption that excuses them from having health insurance if they live in an area where there are no marketplace plans or only one insurer selling marketplace plans. In addition, people can seek a hardship exemption if they can’t find an affordable marketplace plan that doesn’t cover abortion. Finally, consumers can get out of having coverage if they experience “personal circumstances” that make it difficult for them to buy a marketplace plan, including not being able to find a plan in their area that gives them access to specialty care they need.
Expanding the state waivers under Section 1332 would allow states to move their health insurance marketplaces away from the ACA’s requirements. In particular, states that apply for these waivers could permit the ACA subsidies to be used for short-term health plans and association health plans that don’t cover the full range of health benefits specified under the health care law.
Also, the cost of premiums on the federally facilitated health insurance exchanges came down for the 2019 open enrollment period. The Trump administration announced that, on average, prices on the Healthcare.gov exchange are 1.5 percent lower for 2019 than they were last year.
More carriers entered the marketplace and offered new plan options. Insurers now have a better idea of what their costs would be after six years of the ACA and some insurance companies are beginning to turn a profit on their exchange business.
Where does all this leave health insurance brokers?
“It seems like it’s a mixed bag,” said B. Ronnell Nolan, president and CEO of Health Agents for America.
“Some of our members are excited about selling short-term medical and association plans. Some members are still in the individual market where they are not getting paid commissions and they’re still struggling. So I guess it depends on what market or even what state they’re in. Because some states increased commissions a little bit but some aren’t paying during special enrollment periods.”
Nolan characterized the past year as positive overall for her organization’s members.
“I think we are making strides,” Nolan said. “I think the administration realizes our agents are important to the process. They recognize when we have problems, such as the commission issue.”
She praised the administration’s changes to the health care law as “allowing consumers to buy what they want and not necessarily what the government thinks they need. But we have to do our part and educate consumers about what they are purchasing.”