Health Reform

The Rise of Health Care Sharing Ministries

By | Health Insurance, Health Reform

Healthcare-Sharing-MinistriesEarlier this year, insurance regulators from both Texas and Washington state filed orders against Aliera Healthcare, a health care sharing ministry (HCSM), after some of its members filed complaints about denied or delayed payments on their medical claims.

At first glance, this may seem like business as usual in the insurance commissioner’s office. Yet, organizations like Aliera—religious groups where members pay a set monthly amount to share costs and help pay each other’s medical bills—are not insurance plans, per se. Rather, they are alternatives to ACA health plans that allow members to pay.

“HCSMs have been around since well before the ACA—the first ones came about in the 1990s,” says JoAnn Volk, a member of the Center on Health Insurance Reforms at Georgetown University who contributed to a 2018 Commonwealth Fund report discussing the risks of health care sharing ministries to consumers and insurance plans. “Think of them a bit like Amish communities who all come together, sharing resources and labor to build a neighbor’s barn. With these ministries, like-minded individuals can come together and share in each other’s medical costs.”

While, originally, members of such ministries may have flocked together because of shared religious beliefs, Volk says the ACA has pushed more people to consider these arrangements for other reasons.

“We are hearing about a lot of growth in HCSMs now,” she says. “And that increase in growth seems more spurred by people who are concerned about higher premiums for ACA coverage than truly believing in a ministry’s religious tenets. They can pay less per month and have confidence that they won’t be hit by with a mandate penalty. There’s only one problem: it’s not insurance and there is no actual promise that an HCSM will pay your medical bills.”

Related: The Future of the ACA

In fact, most HCSMs do not cover pre-existing conditions or preventative services. Due to their religious foundation, they also aren’t inclined to cover birth control, mental health services, or addiction treatment. In addition, there may be caps, or limits on the total amount that the group will pay for any single medical treatment. And more consumers are reporting that HCSMs are not paying their claims for medical care.

Despite those limitations, the number of memberships continues to grow. The Alliance for Health Care Sharing Ministries, the trade group that represents these groups, suggests that memberships have grown into the millions over the past few years. But it’s unclear whether or not that is accurate, says Volk. Unlike health insurance plan numbers, membership in HCSMs is not tracked by regulatory agencies. Nor do those agencies have much leverage to educate consumers about what HCSMs are required—and not required—to provide with membership or to intervene with consumer complaints.

“These organizations get a carve out from insurance regulations because they are not insurance,” she says. “But nomenclature that can be quite confusing to consumers. And even though they are required to say they are not insurance, it gets overwhelmed by all the insurance-like features they use to market and promote themselves. Again, there is no promise to pay—and members often don’t seem to realize that.”

Volk cites coverage options with descriptions like “bronze, silver, and gold,” as well as monthly contributions based on age and the number of people in your family that look and work much like the premiums one might see with insurance plans. And brokers who also sell ACA plans may also have HCSMs on their option lists, which make them seem like actual insurance plans.

It’s why many members are registering complaints. But with religious exemptions and other legislative protections in place, there is little recourse. Aliera, in fact, plans to fight the cease-and-desist action filed against them by Washington state.

“It really is a wild, wild west out there for fraudsters and aggressive marketing tactics with these kinds of organizations,” says Volk. “It’s been hard for state officials to step in and do anything. And as we hear more about stories about people not having their bills paid, it should raise pressure for states to take a fresh look on what they should be doing to protect consumers and providers from these HCSMs.”

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Kayt Sukel, June 24, 2019, Executive Express, Industry Analysis, News

Democrats are out to sabotage the middle class on health care

By | Health Reform

Democrats are trying to ban low-cost health insurance that covers less than ObamaCare.

Betsy McCaughey, August 14, 2018health-care-trump
Betsy McCaughey is a senior fellow at the London Center for Policy Research.

Democrats claim they’re protecting the public from what Sen. Chuck Schumer calls “junk insurance.” Don’t believe it.

In truth, they’re sabotaging middle-class consumers who’ve been priced out of ObamaCare.

The Affordable Care Act requires all health plans to cover 10 categories of medical care that Washington politicians deem “essential.” Everything from maternity (even if you’re in your 50s) to substance-abuse treatment. It’s like passing a law saying the only car you can buy is a fully loaded SUV. Some people just need wheels.

If you need health insurance, basic coverage without the costly extras sure beats being uninsured.

Trouble is, ObamaCare is a budget buster. Premiums for 2019 will be about triple what they were six years ago. Not a problem for buyers who get subsidized by Uncle Sam. But it’s a big problem if you earn more than $48,560 individually or $65,840 as a couple, and can’t get a subsidy.

One out of every five of these unsubsidized ObamaCare customers dropped their insurance last year and went uncovered, a trend predicted to worsen this year. Not that Schumer and the rest of Congress feel the pain. They get their own sweetheart deal.

Meanwhile, the middle class is becoming the new uninsured. Somebody needs to remind the Democratic Party that poor lives matter but so do middle-class lives.

Enter Trump. On Aug. 1, the administration announced regulatory changes that’ll allow sticker-shocked consumers to buy “short term” health plans without costly extras like newborn care and pediatric dental coverage that are mandatory (even for single guys) in ObamaCare plans. The short-term plans, which can last three years, will cost less than half what ObamaCare costs, in some cases only a quarter as much. About 600,000 consumers are expected to snap up these lower-cost plans in the first year, 2 million by 2023.

Disregard panicky predictions that consumers who don’t read the fine print will get a rude awakening. Trump’s regulations require exclusions to be spelled out in huge typeface no one can miss. Buyers will know what they’re not getting before they sign up.

How about Dem Sen. Tammy Baldwin’s rants about “junk” coverage? False. These low-cost plans will probably provide better access to hospital and doctors than ObamaCare plans, which often exclude specialty hospitals like MD Anderson Cancer Center in Texas and Memorial Sloan Kettering Cancer Center in New York, and include only doctors who take bargain-basement Medicaid fees.

Schumer tries to claim people with pre-existing conditions will be harmed because their ObamaCare premiums will rise as healthy people leave for less-costly alternatives. Sorry, senator, that’s another whopper. According to America’s Health Insurance Plans, the impact will be nearly imperceptible — under 2 percent.

Never mind hard facts. The Democratic Party is determined to outlaw low-cost alternatives to ObamaCare. They’re taking their battle to the states, which have the authority to ban these plans. Hawaii, Maryland, Connecticut and Washington state recently slammed the door on them. California is expected to follow. Consumers in most states will be free to buy low-cost options thanks to the Trump regulatory change, but not in these health-insurance gulags.

New York is the worst. Consumers here have the least freedom of choice and pay practically the highest premiums in the country. Even before ObamaCare, New York legislators pandered to interest groups by requiring that all plans cover a huge range of services.

Here’s how it works: Lobbyists get paid by chiropractors, infertility experts and other interest groups to push for mandatory coverage, and state legislators rake in contributions and accolades for going along. Everybody wins but John Q. Consumer, the middle-class chump who gets clobbered when he buys insurance.

Meanwhile, people who live in states with more health-insurance freedom will be saving thousands of dollars a year.


Trump Throws A Life Belt To People Who Buy Their Own Health Insurance

By | Health Insurance, Health Reform

new Treasury ruling will allow people to buy health insurance that has lower premiums, lower deductibles and broader networks of providers.1st-HHS-Graohic

John C. Goodman Aug 6, 2018, 06:00 am

For the first time since the enactment of Obamacare, people will be able to buy insurance that meets individual and family needs rather than the needs of politicians and bureaucrats. They will also be able to pay actuarially fair premiums.

These new plans are predicted to be popular, with the expected number of enrollees ranging from 1.9 million (Medicare’s chief actuary) to 2.1 million (Urban Institute). The Congressional Budget Office and the Joint Committee on Taxation put the number at 2.0 million.

So, who could be against this welcome opportunity? Answer: Almost everyone, except the people who plan to buy the insurance, that is.

The opponents include Blue CrossAHIP (the insurance industry’s trade group) and virtually every other stakeholder. Before finalizing the rule, the government received about 12,000 comments. According to an analysis by the Los Angeles Times, 98% of them were negative. “Not a single group representing patients, physicians, nurses or hospitals voiced support,” the newspaper noted.

Think about that. Roughly 2 million people are about to get the opportunity to buy insurance that meets their needs for a fair price and virtually every special interest in the entire health care system wants to stop them.

Why is that? Explanation below. But remember, there was a reason why the Berlin Wall was manned by armed guards for so many years, keeping people from crossing to freedom.

The ruling pertains to “short-term, limited duration” health plans. These plans are exempt from Obamacare regulations, including mandated benefits and a prohibition on pricing based on expected health expenses. Although they typically last up to 12 months, the Obama administration restricted them to 3 months and outlawed renewal guarantees that protect people who develop a costly health condition from facing a big premium hike on their next purchase.

The Trump administration has now reversed those decisions, allowing short-term plans to last up to 12 months and allowing guaranteed renewals up to three years. The ruling also allows the sale of a separate plan, call “health status insurance,” that protects people from premium increases due to a change in health condition should they want to buy short-term insurance for another 3 years.

By stringing together these two types of insurance, people will likely be able to remain insured indefinitely. The new plans will probably include most doctors and hospitals in their networks. And they are likely to look like the kind of insurance that was popular before we had Obamacare.

In explaining the motivation for the ruling, the Treasury Department document points to an “alarming” 20% decline last year in the number of people who are enrolled in the individual market and not getting subsidies (e.g., an individual earning more than $48,160). In some states, the decline was even worse, with enrollment dropping by more than 40% in six states, including a 73% decline in Arizona.

These are the classic symptoms of a death spiral. Over the past four years, many people have seen their insurance premiums double and in some cases triple, while the networks have shrunk so much that they omit the best doctors and the best hospitals.

The Treasury document says that in half the counties in the country, there is only one monopoly insurer. In most cases the insurer is a Medicaid contractor. The plans they are selling look like Medicaid, or something even worse.

So why are so many organizations opposed to giving people a way out?

Because most people in health care believe in private sector socialism, at least when they are not advocating public sector socialism. They don’t want you to be able to buy health insurance for a fair premium, the way you buy life insurance, homeowner’s insurance, or any other kind of insurance.

In short, they want the healthy to over-pay so that the sick can underpay. And the only way that can happen is if the healthy are trapped with no means of escape.

Put differently, the Obama administration and Democrats in Congress wanted to give a gift to a small number of high-cost patients who migrated from group plans to the individual market and faced exclusions, riders or outright denial of coverage. The goal was commendable, but they didn’t want to pay for it with taxpayer dollars. Instead, for the last four years, they have been trying to pay for this benefit by pushing the cost off on other insurance buyers.

The individual market is a small part of the market for private health insurance – only 5% to 6% of the total. Yet the states have been allowed to end their risk pools and dump those enrollees into this market. Similarly, cities and counties and large employers have been able to end their post-retirement health plans and send their high-cost retirees to the individual market. Chronic patients in employer plans also now have an opportunity to go to the individual market for subsidized insurance.

These developments have caused premiums to skyrocket, deductibles to soar, and created a race to the bottom on quality and access to care.

Take the case of an Iowa teenager with a rare case of hemophilia. This one patient cost Wellmark Blue Cross & Blue Shield $1 million a month and was responsible for 10 percentage points of Wellmark’s 43% premium increase last year in Iowa’s tiny individual market. It helped spur the insurer’s complete withdrawal from the market this year.

This is an example of a social problem that society as a whole should resolve. There is no reason to make the small number of people who buy their own insurance shoulder the entire cost, and to build the health equivalent of a Berlin Wall in an effort to keep them from paying actuarially fair prices for insurance that meets their needs.

I am one of the nation’s leading thinkers on health policy. I am a Senior Fellow at the Independent Institute and author of the widely acclaimed book, Priceless: Curing the Healthcare Crisis. The Wall Street Journal calls me “the father of Health Savings Accounts.”

Short-Term Plans Rule Flips the Political Narrative on Health-Insurance Protections

By | Health Reform
By Michael F. Cannon

The usual narrative is that Democrats support consumer protections and Republicans oppose them. Today’s short-term plans final rule flips that narrative: Republicans are expanding consumer protections, and Democrats are opposing them.

Today’s rule reverses a 2016 Obama rule. The Obama rule reduced consumer protections in short-term plans by exposing sick patients to medical underwriting. Before that rule, consumers could purchase short-term plans that lasted 12 months. If they developed a serious illness, their plan could cover them until the next ObamaCare open enrollment period, when they could purchase coverage without medical underwriting. The Obama rule restricted short-term plans to 3 months. It prohibited “renewal guarantees” that protect enrollees who fall ill from medical underwriting when they purchased a new short-term plan. As a result, the Obama rule left short-term plan enrollees who got sick with no coverage for up to 9 months: those who purchased a plan in January, and developed a serious illness in February, would lose their coverage at the end of March, and have no coverage until the following January. (Source: NAIC) This was by design: the Obama administration wanted to expose sick people in short-term plans to medical underwriting and lost coverage as a way of forcing consumers to buy ObamaCare coverage instead. That’s at least a little messed up.

Today’s rule allows short-term plans to last 12 months and offer renewal guarantees. It therefore allows short-term plans to protect the sick from medical underwriting for an additional 9 months—indeed, “issuers may offer coverage under a short-term, limited-duration insurance policy for up to a total of 36 months, without any medical underwriting or experience rating beyond that completed upon the initial sale of the policy”—and allows renewal guarantees to protect them from medical underwriting indefinitely. Protecting the sick from medical underwriting has long been a goal of Congress.

So, to recap, Republicans are expanding consumer protections, and Democrats are opposing an expansion of consumer protections.

Weird, isn’t it?

More Affordable Health Insurance Options On Their Way!

By | Health Reform

downloadTrump Administration Delivers on Promise of More Affordable Health Insurance Options

HHS final rule on short-term, limited-duration insurance brings more flexibility and choices to consumers

On Wednesday, the departments of Health and Human Services, Labor and the Treasury issued a final rule to help Americans struggling to afford health coverage find new, more affordable options. The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total. This action will help increase choices for Americans faced with escalating premiums and dwindling options in the individual insurance market.

“Under the Affordable Care Act, Americans have seen insurance premiums rise and choices dwindle,” said Health and Human Services Secretary Alex Azar. “President Trump is bringing more affordable insurance options back to the market, including through allowing the renewal of short-term plans. These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.”

In a recent release of three reports on the current state of the individual insurance market, Centers for Medicare & Medicaid Services (CMS) data reveal serious problems. While enrollment data show stable enrollment for subsidized exchange coverage, the number of people enrolled in the individual market without subsidies declined by an alarming 20 percent nationally in 2017, while at the same time premiums rose by 21 percent. Many state markets experienced far more dramatic declines, with unsubsidized enrollment dropping by more than 40 percent in six states, including a 73 percent decline in Arizona.

These troubling trends were besetting individual markets as President Trump took office, which led the President to issue the executive order “Promoting Healthcare Choice and Competition Across the United States” in October 2017. The executive order seeks to address the failings of the ACA, which severely limited the choice of healthcare options available to many Americans and produced large premium increases in many state individual markets for health insurance.

“We continue to see a crisis of affordability in the individual insurance market, especially for those who don’t qualify for large subsidies,” said CMS Administrator Seema Verma. “This final rule opens the door to new, more affordable coverage options for millions of middle-class Americans who have been priced out of ACA plans.”

Short-term, limited-duration insurance, which is not required to comply with federal market requirements governing individual health insurance coverage, can provide coverage for people transitioning between different coverage options, such as an individual who is between jobs, or a student taking time off from school, as well as for middle-class families without access to subsidized ACA plans. Access to these plans has become increasingly important as premiums have escalated for individual market plans, and affordable choices for individuals and families have dwindled.

The average monthly premium for an individual in the fourth quarter of 2016 for a short-term, limited-duration policy was approximately $124, compared with $393 for an unsubsidized individual market plan.

The final rule can be found here: – PDF

A fact sheet on today’s proposed rule can be found here:

** People using assistive technology may not be able to fully access information in this file. For assistance, contact

Changes in Enrollment in the Individual Health Insurance Market

By | Health Insurance, Health Reform

The Affordable Care Act (ACA) expanded health insurance coverage in part by prohibiting discrimination against people with pre-existing conditions and offering subsidies to low-income people purchasing through newly-created exchanges on the individual insurance market. In this analysis, we use publicly-available federal enrollment data and administrative data insurers report to the National Association of Insurance Commissioners (as compiled by Mark Farrah Associates) to measure changes in enrollment in the individual market before and after the ACA’s coverage expansions and market rules went into effect in 2014 through the first quarter of 2018.

The individual market comprises coverage purchased by individuals and families through the ACA’s exchanges (Marketplaces) as well as coverage purchased off-exchange, which includes both plans complying with the ACA’s rules and non-compliant coverage (e.g., grandfathered policies purchased before the ACA went into effect and short-term plans). It is a relatively small market as a share of the U.S. population, with about 10.6 million people enrolled in 2013 before the ACA went fully into effect1.

Our analysis finds that, after increasing substantially (by 64% to 17.4 million people in 2015) following implementation of the ACA, enrollment in the individual market remained relatively unchanged in 2016 (at 17.0 million) then declined by 12% to 15.2 million in 2017. Enrollment has continued to fall in early 2018: first quarter enrollment has declined by 12% in 2018 compared to the first quarter of 20172. Much of this decline in overall individual market enrollment was concentrated in the off-exchange market, where enrollees are not eligible for federal premium subsidies and therefore were not cushioned from the significant premium increases in 2017 and 2018. Despite the recent decline in overall individual market enrollment, there are still 14.4 million people enrolled as of the first quarter of 2018, compared to 10.6 million people in 2013.

Changes in Enrollment through 2018

As the ACA market rules and premium subsidies were implemented in 2014, there was significant growth in enrollment on the individual market. For the first time in nearly all states, people with pre-existing conditions could purchase coverage on an open marketplace and low-income people were eligible for tax credits to help pay their premiums and reductions in their cost sharing. In addition, many people who went without insurance coverage had to pay a tax penalty. As of 2014, health plans had to follow new rules that standardized benefits and guaranteed coverage for those with pre-existing conditions when selling coverage to new customers (known as “ACA-compliant” plans). Following these changes, individual market enrollment increased substantially, expanding from 10.6 million members on average per month in 2013 to 17.4 million members in 2015 (Figure 1)3. This included an estimated 3.5 million people in non-ACA compliant plans — including short term plans, grandfathered plans, and plans purchased before October 2013 that were allowed to continue under a federal transition policy at the discretion of states and insurers.

In 2016, total individual market enrollment was relatively unchanged from the previous year (at 17.0 million), though there was an apparent shift from non-compliant to ACA-compliant plans. In 2016, enrollment in non-compliant plans decreased by 1.3 million (38%), while ACA compliant enrollment (including both on and off-exchange plans) increased by 1 million people.

Enrollment in the total individual market began to decline in 2017. Both compliant and non-compliant enrollment declined, suggesting that people ending transitional, non-compliant policies were not necessarily moving to the ACA-compliant market. In 2017, the individual market covered 15.2 million people on an average monthly basis, including 13.3 million people in compliant plans on and off the exchanges and 1.8 million people in non-compliant plans.

First quarter enrollment data from 2018 shows that total individual enrollment continues to decline, even as enrollment on the ACA exchanges has remained relatively stable (see Figure 3). 14.4 million people are enrolled in the individual market as of the first quarter 2018, 12% lower than the first quarter of 2017 – a drop of about 2 million.

Figure 1: Individual Market Enrollment, 2011 – 2017

Changes in On vs. Off-Exchange Enrollment

After peaking at 11.1 million people in 2016, exchange enrollment has declined somewhat but has largely remained stable. In the first quarter of 2018, 10.6 million people were covered on the ACA exchanges, including 9.2 million people receiving federal premium subsidies (Figure 2)4.

Figure 2: Q1 Exchange Enrollment, 2015 – 2018

Declining off-exchange enrollment accounts for much of the drop in individual market enrollment since 2016. Total individual market enrollment began to decline in 2017 and has continued to fall in the first quarter of 2018 (Figure 3). Total individual market enrollment declined by 2 million people (12%) from the first quarter of 2017 to the first quarter of 2018. All of this decline was in the off-exchange market, which fell by 2.3 million people (38%). Exchange enrollment increased slightly by 313 thousand people (3%), reflecting an increase in enrollment among subsidized enrollees and a decrease among those not eligible for subsidies5. The “silver loading” of premiums in response to termination of cost-sharing subsidy payments to insurers in late 2017 inflated premium subsidies in 2018 and made zero-premium bronze plans possible for many more people. This may have boosted enrollment among subsidized consumers in 2018.

Figure 3: Change in Q1 Enrollment, 2017 – 2018

Off-exchange enrollment includes ACA-compliant plans that are sold outside of the exchange but are part of the same risk pool. The primary distinction between on and off exchange ACA-compliant plans is that subsidies are only available through the exchange. To the extent that fewer people in good health buy off-exchange ACA-compliant plans, premiums in on-exchange plans are affected as well. Non-compliant plans – including grandfathered and short-term plans – that are not part of the ACA risk pool -are also included in off-exchange enrollment. In 2017, 3.6 million people were covered by off-exchange ACA compliant plans, and 1.8 million people had non-compliant plans6.

The decline in individual market enrollment coincides with significant premium increases in 2017 and 2018. In the early years of the ACA exchanges, insurers underestimated how sick the new risk pool would be and set premiums too low to cover their claims. A number of insurers then exited the market and the remaining insurers raised premiums substantially on average to match their costs (Figure 4). Our analysis of insurer financials showed the market was stabilizing by 2017 and insurers were starting to become profitable in the individual market for the first time under the ACA. Signs pointed toward the 2017 premium increases being a one-time market correction. However, premiums increased again in 2018, in large part compensating for uncertainty around enforcement of the individual mandate and the termination of cost sharing payments.

Figure 4: Average First Quarter Individual Market Monthly Premiums and Claims Per Person, 2011 – 2018

While the vast majority of exchange consumers receive subsidies that protect them from premium increases, off-exchange consumers bear the full cost of premium increases each year. In 2017, states that had larger premium increases saw larger declines in unsubsidized ACA-compliant enrollment (Figure 5), suggesting a relationship between premium hikes and enrollment drops.

No data are available to determine what is happening to people who have dropped off-exchange coverage. Some may now qualify for subsidies as premiums have risen, some may have obtained coverage elsewhere (e.g., through employer plans, or health care sharing ministries, which are not considered insurance and do not file any enrollment or financial information to regulators), and some may be uninsured.

Figure 5: State Changes in Average Benchmark Premium vs Unsubsidized Enrollment, 2016 – 2017

As off-exchange, unsubsidized enrollment has fallen, the total individual market has increasingly become dominated by subsidized enrollees. In the first quarter of 2018, nearly two-thirds of enrollees in the total individual market are subsidized (Figure 6).

Figure 6: Subsidized vs. Unsubsidized Share of Q1 Individual Market Enrollment


Looking ahead to 2019, the repeal of the individual mandate penalty has raised concerns of further enrollment declines in the individual market, particularly among people who are healthier than average. The expected expansion of loosely-regulated short-term health plans will also likely siphon away healthy people, pushing premiums up further for ACA-compliant plans on and off the exchange.

While the majority of people on the exchanges receive subsidies and will be protected from premium increases, middle-class people who do not qualify for subsidies will feel the brunt of future premium increases. This is especially true of people with pre-existing conditions who likely would not qualify for short-term plans that base eligibility and premiums on people’s health.

The availability of premium subsidies – which rise along with premiums – is likely sufficient to keep the individual insurance market financially sustainable in the face of policy changes and enrollment declines. However, based on the current trajectory, the market is likely to be increasingly dominated by lower-income people and those with pre-existing conditions.


We analyzed publicly-available federal enrollment data from the Centers for Medicare and Medicaid Services (CMS), and insurer-reported enrollment and financial data from Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the National Association of Insurance Commissioners (NAIC) and the California Department of Managed HealthCare. All total enrollment figures in this data note are for the individual health insurance market as a whole, which includes major medical insurance plans sold both on and off exchange.

Exchange and compliant enrollment are from the Centers for Medicare and Medicaid Services (CMS). Total individual market enrollment is from administrative data insurers report to the National Association of Insurance Commissioners, and compiled by Mark Farrah Associates: annual enrollment is from the Supplemental Health Exhibit and first quarter enrollment is from the Exhibit of Premiums, Enrollment, and Utilization for health companies and rolled over from the prior year Supplemental Health Exhibit for life companies. Off-exchange enrollment is estimated by subtracting exchange enrollment from total enrollment in the individual market. Non-compliant enrollment is estimated by subtracting compliant enrollment from total enrollment in the individual market. CMS does not collect enrollment data for off-exchange ACA compliant plans in Massachusetts or Vermont; in these states non-compliant enrollment was estimated by applying the national average share of non-compliant off-exchange members to statewide off-exchange enrollment.

Annual enrollment figures from 2011 – 2017 are for average monthly enrollment. Quarterly enrollment figures in 2018 are for effectuated enrollment (i.e., people who paid their first month’s premiums). Annual filings provide a more complete picture of the individual market and allow for estimates of compliant vs non-compliant enrollment. Quarterly filings provide a sense of how enrollment is changing on a more current basis. First quarter enrollment tends to be higher than average annual enrollment because the number of people who drop coverage throughout the year exceeds the number who purchase coverage through special enrollment periods outside of annual open enrollment.

Trump administration won’t defend ACA in case brought by GOP states

By | Health Insurance, Health Reform
June 7

The Trump administration said Thursday night that it will not defend the Affordable Care Act against the latest legal challenge to its constitutionality — a dramatic break from the executiveACA Not Bening Defended branch’s tradition of arguing to uphold existing statutes and a land mine for health insurance changes the ACA brought about.

In a brief filed in a Texas federal court and an accompanying letter to the House and Senate leaders of both parties, the Justice Department agrees in large part with the 20 Republican-led states that brought the suit. They contend that the ACA provision requiring most Americans to carry health insurance soon will no longer be constitutional and that, as a result, consumer insurance protections under the law will not be valid, either.

The three-page letter from Attorney General Jeff Sessions begins by saying that Justice adopted its position “with the approval of the President of the United States.” The letter acknowledges that the decision not to defend an existing law deviates from history but contends that it is not unprecedented.

The bold swipe at the ACA, a Republican whipping post since its 2010 passage, does not immediately affect any of its provisions. But it puts the law on far more wobbly legal footing in the case, which is being heard by a GOP-appointed judge who has in other recent cases ruled against more minor aspects.

The administration does not go as far as the Texas attorney general and his counterparts. In their suit, lodged in February in the U.S. District Court for the Northern District of Texas, they argue that the entire law is now invalid.

By contrast, the Justice brief and letter say many other aspects of the law can survive because they can be considered legally distinct from the insurance mandate and such consumer protections as a ban on charging more or refusing coverage to people with preexisting medical conditions.

A group of 17 Democratic-led states that have won standing in the case also filed a brief on Thursday night arguing for the ACA’s preservation.

While the case has to play out from here, the administration’s striking position raises the possibility that major parts of the law could be struck down — a year after the Republican Congress failed at attempts to repeal core provisions.

In an unusual filing just before 6 p.m. Thursday, when the brief was due, the three career Justice attorneys involved in the case — Joel McElvain, Eric Beckenhauer and Rebecca Kopplin — withdrew.

The department’s argument, if adopted by U.S. District Judge Reed O’Connor, “would be breathtaking in its effect,’ said Timothy Jost, a retired Washington and Lee law professor who follows such litigation closely. “Of all of the actions the Trump administration has taken to undermine individual insurance markets, this may be the most destabilizing. . . . [If] I’m an insurer, I don’t know what I am supposed to do or not.”

Jost, an ACA supporter, noted that the administration’s decision not to defend the law comes during the season when participating insurers must file their rates for next year with state regulators. It raises new questions about whether insurers still will be required to charge the same prices to all customers, healthy or sick.

And Topher Spiro, vice president of health policy at the liberal Center for American Progress, said the administration’s legal argument contradicts promises by Trump that he would not tamper with the ACA’s protections for people with preexisting medical conditions.

University of Michigan law professor Nicholas Bagley, another ACA defender, went even further in a blog post. “If the Justice Department can just throw in the towel whenever a law is challenged in court, it can effectively pick and choose which laws should remain on the books,” he wrote. “That’s not a rule of law I recognize. That’s a rule by whim. And it scares me.”

Crusading against the ACA has been a priority of Trump’s since his campaign for the White House. On his first night in office, Trump issued an executive order, directing federal agencies to lighten the regulatory burden placed by the law. Last October, the president unilaterally ended a significant part of the law that cushions insurers financially from an obligation to give discounts to decrease out-of-pocket costs to lower-income customers with ACA coverage.

More recently, the White House and Department of Health and Human Services have been working to make it easier for consumers to buy relatively inexpensive health plans that exclude some of the benefits the ACA requires.

The new challenge comes six years after the Supreme Court’s divided ruling that the ACA is constitutional. That ruling hinged on the reasoning that, while the government “does not have the power to order people to buy health insurance,” as Chief Justice John G. Roberts Jr. wrote for the majority, it “does have the power to impose a tax on those without health insurance.”

The case in Texas, which has attracted relatively little notice until now,emerges from the massive tax bill Congress passed late last year. In that, lawmakers decided to eliminate the tax penalty the ACA requires people to pay if they flout the insurance mandate. The enforcement of that requirement will end in January.

As a result, the Texas lawsuit contends, “the country is left with an individual mandate to buy health insurance that lacks any constitutional basis. . . . Once the heart of the ACA — the individual mandate — is declared unconstitutional, the remainder of the ACA must also fall.”

Texas and the accompanying states have asked for a preliminary injunction that could suspend the entire law while the case plays out in court.

But the administration disagrees with that position. Instead, Justice officials argue in their brief that the ACA’s insurance requirement will not become unconstitutional until January, so that “the injury imposed by the individual mandate is not sufficiently imminent” and that the judge could issue a final ruling in the case before then.

O’Connor, who is hearing the suit, was appointed by President George W. Bush and has ruled against the ACA in other cases the past few years.

Until Thursday’s filing, the Trump administration had not indicated its position on either this latest lawsuit or the Republican states’ effort to block the law while the case moved along.

New Ruling makes Short Term Medical into “Trump Care”

By | Health Reform

Highlights of Proposed Ruling:Update

  • The preliminary final ruling vindicates Short Term Medical as a viable alternative to ACA ( Obamacare). The ruling cites lower cost and more access to providers via PPOs and changes the penalty for not having an ACA Plan to Zero Starting January 1, 2019.
  • The New Ruling resets the duration of Short Term Medical Plans to 12 months (as it was for the last 20 years).
  • In addition, they are considering processes for expedited or streamlined reapplication for short-term limited-duration insurance that would simplify the reapplication process and minimize the burden on consumers.

The result will be to make Short Term Medical Plans easy to reapply for after the initial 12 month period.

Other comments touting the benefits of Short Term Medical are:

  • Individuals who purchase short-term, limited-duration insurance (as opposed to being uninsured would) potentially experience improved health outcomes and have greater protection from catastrophic health care expenses.
  • Individuals purchasing short-term, limited-duration policies could obtain broader access to health care providers compared to those ACA-compliant plans that have narrow provider networks.
  • Short-term, limited-duration insurance policies can be priced in an actuarially fair manner, subject to State law saving consumers over 70% off cost of ACA plan.

To see the actual proposal click here for PDF (make sure you download it).

Contact Mark Deschenes 800-257-1723 at to get your quote and see how much you can save.

Our Layered Approach To Healthcare Protection

By | Health Insurance, Health Reform

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Are you discouraged by your high Premiums at work, upset that you can’t keep your Doctor on your Obamcare HMO, or worse yet are locked out of coverage all together because you missed Open Enrollment?

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UPDATE: Republicans Can’t Kill Obamacare, So They’re Turning It Into Trumpcare

By | Health Reform

UpdateAny day now, the Trump administration will unveil a proposal to change the regulation of short-duration insurance plans. These are plans that don’t typically include mental health or other essential benefits the Affordable Care Act requires, and they are almost never available to people with pre-existing conditions – which means insurers can sell them for a lot less money.

Once the Affordable Care Act took effect, the Obama administration decided short-term plans would not count toward satisfying the individual mandate and that, as of this year, they could last no more than three months. As with so many other decisions the Obama administration made, this was both an effort to protect people from insurance that would leave them exposed to catastrophic medical bills as well to make sure insurers selling comprehensive, regulated plans weren’t losing healthy customers to cheaper alternatives unavailable to the sick.

The Trump administration plans to alter those rules, and, although the details are not public, it’s likely that the plans will officially be available for up to a year, as they were previously, and that they will count toward the mandate,  if the mandate-still exists. If healthy people can buy these plans or longer than three months and can do so without incurring a financial penalty from  the mandate, many  more are likely to choose that option – causing insurance markets to deteriorate even more as premiums for comprehensive policies go up and more people seek out cheaper alternatives.