There’s no universal way for states to approach oversight of association and short-term health plans, experts say.
Jessica Altman, the commissioner of the Pennsylvania Insurance Department, said her state is a prime example of this. Pennsylvania has had a rough history with AHPs, so they’re regulated tightly, while the rules for short-term plans are looser.
“It is really variable by state, and different states have different histories, different laws, different regulatory approaches,” Altman said at America’s Health Insurance Plans’ National Conference on the Individual and Small Group Markets Friday morning.
The White House finalized its expansion of both short-term and association health plans last summer, with the goal of providing additional coverage options to people who may fall outside of the Affordable Care Act exchanges’ subsidies.
Both types of health plans are controversial, as they can offer skimpier coverage than is required under the ACA—which could leave patients, particularly those in need of chronic care, out to dry.
Sabrina Corlette, research professor at the Center on Health Insurance Reforms at Georgetown University, said there is limited data available about the uptake of these alternative insurance options. Corlette and her team at the Georgetown University's Health Policy Institute have studied the marketing, however, and found that search results for ACA or Obamacare plans are often dominated by results for short-term coverage.
In addition, Corlette said a customer profile built on this research indicates that insurers operating these plans aren’t necessarily targeting just people who may just miss qualifying for ACA subsidies—the audience the Trump administration says these plans are for.
“The target population is any willing buyer,” Corlette said, “and unfortunately the brokers and the websites that we surveyed or reviewed do not make it clear that people are not buying comprehensive coverage—and it may leave them financially exposed.”
Altman said that states looking to boost oversight of these plans are taking several different measures, with some revoking licenses for plans that mislead consumers or passing legislation that keeps the length of short-term plans below that twelve months backed by the Trump administration.
Corlette also noted that some states with tighter oversight of short-term plans already had those laws in place before the White House rule was finalized—leading some to consider loosening restrictions.
Plus, short-term plans and AHPs aren’t the only alternative insurance options that are drawing in potential exchange plan members, they said. Health-sharing ministries and direct primary care—which can often be marketed together—are also segmenting the consumer populations.
Rules governing these coverage options also vary. Altman said Pennsylvania state law, for example, blocks her office from regulating ministries.
These plans are also marketing aggressively, Corlette said.
“For the most part, I’m not aware of any state currently actively regulating them,” she said.