Allowing the spread of low-quality insurance plans designed to attract younger, healthier Americans would ultimately put meaningful coverage beyond the reach of millions of the most vulnerable patients, the Academy recently reminded HHS.
The AAFP warned of the consequence of allowing insurers to sell policies that do not comply with the Patient Protection and Affordable Care Act across state lines in a May 1 letter(2 page PDF) to HHS Secretary Alex Azar that was signed by Board Chair Michael Munger, M.D., of Overland Park, Kan. The Academy wrote in response to an HHS request for information(www.govinfo.gov) published in the March 11 Federal Register.
The agency sought comments on how to promote sales of individual health insurance plans across state lines, primarily through the multistate health care choice compacts allowed under the ACA. Six states now allow such compacts, but insurers have yet to participate.
The Academy's response was a full-throated objection.
"We recognize that noncompliant plans could expand affordable access to a minimal level of health coverage for certain individuals," it said. "However, the AAFP is strongly opposed to these proposals, since these plans do not provide meaningful insurance coverage for all, including, most notably, those with complex medical conditions or the very ill."
Noncompliant plans harm patients by reducing or eliminating coverage of the essential health benefits required by the ACA, the AAFP said. Among the protections that would be at risk are the prevention of insurance discrimination based on health status, age or gender, and coverage for preexisting conditions.
An increase in noncompliant plans would lead to rising premiums for those enrolled in plans that are compliant, the Academy cautioned. "Women, older and sicker Americans would likely face higher costs and fewer affordable insurance options," the AAFP said.
Reducing or abandoning EHBs, the Academy wrote, "could potentially make plans more expensive for people with long-term chronic conditions or with sudden medical emergencies," while allowing others to gamble that low-quality insurance will stand up to crises or unexpected needs.
The AAFP further noted that it isn't alone in its objections.
"Many states have adopted regulations restricting access, duration and renewability to short-term, limited-duration plans," the letter said. Allowing the sale of such policies across state lines would preempt state authority and erode consumer protections while undermining states' ability to regulate their own markets.
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