WASHINGTON -- The White House said Friday that its recent actions on healthcare -- such as allowing the sale of health plans that aren't compliant with Affordable Care Act (ACA) rules -- are saving taxpayers money and providing healthcare consumers with more choices, but experts say some of the new plans may not provide consumers with comprehensive coverage.
In a report released Friday, the White House's Council of Economic Advisers finds that actions by the Trump administration to deregulate healthcare will save consumers $450 billion over the next 10 years -- $140 billion from the elimination of the ACA's individual mandate penalty, $80 billion as a result of permitting more small businesses to form association health plans (AHPs), and $80 billion from the expansion of short-term, limited-duration (STLD) insurance plans.
"All of this while maintaining protections for preexisting conditions," a senior administration official said on a phone call with reporters.
The remaining $150 billion comes from a reduction in the "excess burdens of labor taxation" -- the economic losses suffered by society as a result of being taxed, according to the report.
The savings from getting rid of the ACA's penalty for not buying health insurance -- a penalty that the federal government can no longer collect -- are "surprising," the report notes, but they occur because consumers who are no longer forced to buy health insurance on the exchanges also won't be getting any premium subsidies from the federal government, the report explained. (In 2018, the penalty itself was $695 per person, or 2.5% of an individual's yearly household income, whichever was greater.)
"We estimate that the reforms will benefit lower and middle-income consumers, and all taxpayers, but will impose costs on some middle- and higher-income consumers, who will pay higher insurance premiums," the report concluded. "The benefits of giving a large set of consumers more insurance options will far outweigh the projected costs imposed on the smaller set who will pay higher premiums. We provide estimates that these reforms do not 'sabotage' the ACA but rather provide a more efficient focus of tax-funded care to those in need."
The administration official's comment that STLD plans and AHPs protect consumers with preexisting conditions appears contrary to published reports. An analysis last year from the Kaiser Family Foundation stated that STLD plans "are often medically underwritten -- applicants with health conditions can be turned down or charged higher premiums, without limit, based on health status, gender, age, and other factors." The report also noted that the STLD plans "exclude coverage for preexisting conditions -- policyholders who get sick may be investigated by the insurer to determine whether the newly diagnosed condition could be considered preexisting and so excluded from coverage."
To test the hypothesis that STLD plans would not cover patients with preexisting conditions, Kaiser researchers submitted applications to 38 STLD plans for a 35-year-old HIV-infected male. All 38 plans rejected the applicant. "We also found that STLD insurance would generally not meet the needs of someone [who] was diagnosed with HIV while enrolled, due to benefit limitations, particularly for prescription drugs, and high out-of-pocket costs," the investigators noted. The Commonwealth Fund noted in an August 2018 report that AHPs "may offer a health plan that is exempt from key ACA individual and small-group market consumer protections. These plans may, for example, exclude essential health benefits or charge a higher premium based on a person's gender or occupation."
Asked about the idea that the STLD plans may not be as comprehensive as ACA-compliant plans, the senior administration official replied, "I think the analysis reflected [it] is better for the people to [be] covered with short-term plans than to be uninsured."
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