Breaking News
March 20, 2018 - Epidural stimulation can safely, effectively normalize blood pressure in patients with SCI
March 20, 2018 - ‘Fast track’ project shows promising results in cancer whole genome analyses
March 20, 2018 - Advanced insulin pump system can also manage type 1 diabetes in children, study shows
March 20, 2018 - Flu risk less on flights if in a window seat finds study
March 20, 2018 - Sarepta Therapeutics Announces Plan to Submit a New Drug Application (NDA) for Accelerated Approval of Golodirsen (SRP-4053) in Patients with Duchenne Muscular Dystrophy (DMD) Amenable to Skipping Exon 53
March 20, 2018 - Post-Transplant Fatty Liver Disease on the Rise
March 20, 2018 - New mutation linked to ovarian cancer can be passed down through dad
March 20, 2018 - Scotland study aims to offer precise diagnoses for people with rare genetic diseases
March 20, 2018 - Stem cell treatment may help rejuvenate ovaries, avoid effects of premature menopause
March 20, 2018 - FDA Approves Hizentra (Immune Globulin Subcutaneous [Human] 20% Liquid) for the Treatment of Patients With Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
March 20, 2018 - Death Strikes Young in RA
March 20, 2018 - Quiescent cells also mutate
March 20, 2018 - Stem cell-derived ocular cells treat severe AMD
March 20, 2018 - Mediterranean diet appears to be good for postmenopausal women’s bones and muscles
March 20, 2018 - Scientists discover rare childhood liver cancer’s ability to metastasize to the brain
March 20, 2018 - Treating metastatic breast cancer with immunotherapy
March 20, 2018 - The 5:2 diet could have beneficial impact on important risk markers for cardiovascular disease
March 20, 2018 - Congress tackles the opioid epidemic. But how much will it help?
March 20, 2018 - Neanderthals Just Part of the Evolutionary Puzzle
March 20, 2018 - Higher Mortality With Surgery for Early NSCLC
March 20, 2018 - Researchers go skin deep to explore what causes wrinkles
March 20, 2018 - E-cigarette use linked to fat accumulation in the liver
March 20, 2018 - Fearful worms provide new clues about human anxiety
March 20, 2018 - Oral micronized progesterone may reduce hot flashes, night sweats in perimenopausal women
March 20, 2018 - Newer treatment for type 2 diabetes reduces liver fat in patients with NAFLD
March 20, 2018 - I.D. Break: PrEP Map; Faulty Flu Meds; Better Zika Test?
March 20, 2018 - Bronchial thermoplasty can improve severe asthmatic cough
March 19, 2018 - Speeding up wound healing using nanofiber dressings
March 19, 2018 - Summit Announces New Analysis Showing Ezutromid Significantly Reduced Muscle Inflammation in Phase 2 Clinical Trial in DMD
March 19, 2018 - Optimizing Sham Acupuncture: That’s Improbable!
March 19, 2018 - Women who have gestational diabetes in pregnancy are at higher risk of future health issues
March 19, 2018 - Viagra cuts colorectal cancer risk in animal model
March 19, 2018 - Vitamin B12 supplementation could postpone disease progression in Parkinson’s patients
March 19, 2018 - Study shows that omega-6 fatty acids could protect against premature death
March 19, 2018 - TherapeuticsMD Announces FDA Acceptance of New Drug Application (NDA) and Prescription Drug User Fee Act (PDUFA) Date for TX-001HR
March 19, 2018 - Minorities More Sensitive To Pain? Pain Medicine News Report
March 19, 2018 - Low blood sugar poses unaddressed threat to people with type 2 diabetes
March 19, 2018 - ACEA goes live with exhaustive, searchable library of NovoCyte publications
March 19, 2018 - Consumption of low-calorie sweeteners could promote metabolic syndrome, increase diabetes risk
March 19, 2018 - Wearable medical patch shows promise for early detection of hypoglycemia in type 1 diabetes
March 19, 2018 - High-energy breakfast leads to better diabetes control and weight loss
March 19, 2018 - D.C. Week: Community Health Centers Get Azar’s Love
March 19, 2018 - Younger siblings of SIDS victims have four-fold increased risk of sudden death
March 19, 2018 - Toothpaste alone does not prevent dental erosion or hypersensitivity
March 19, 2018 - Discovery aids understanding of amyotrophic lateral sclerosis
March 19, 2018 - Hormone imbalance may be reason for higher diabetes rates among men with insufficient sleep
March 19, 2018 - Docs worry there’s ‘nowhere to send’ new and expectant moms with depression
March 19, 2018 - Obesity linked to increased DNA damage in breast epithelium of BRCA mutation carriers
March 19, 2018 - Heart rate increases with higher alcohol consumption
March 19, 2018 - Template produced for clinically validated DIY stethoscope
March 19, 2018 - Experts highlight nocturia as most common cause of poor night’s sleep
March 19, 2018 - Fit Middle-Aged Women May Fend Off Dementia Later
March 19, 2018 - Fake Insta Doc; Humana’s Weird Pay Bump Tax Trick; Few NPDB Searches
March 19, 2018 - Guidelines for fluoride intake—are they appropriate?
March 19, 2018 - Race and pre-pregnancy BMI may be key predictors of maternal weight gain
March 19, 2018 - Telediabetes program improves blood sugar control for veterans
March 19, 2018 - Research suggests breastfeeding as protective factor against obesity in high-birthweight infants
March 19, 2018 - Morning Break: House Nixes ‘Right-to-Try’ Bill; Purdue’s PR Makeover; Air in the Brain
March 19, 2018 - Heart researchers develop a new, promising imaging technique for cardiac arrhythmias
March 19, 2018 - Mice study shows how BPA exposure during pregnancy can lead to altered brain development
March 19, 2018 - Breastfeeding mothers who overeat may increase risk of health problems in offspring
March 19, 2018 - New mobile application can detect atrial fibrillation that causes strokes
March 19, 2018 - Study finds low rates of preconception counseling among women of childbearing age with diabetes
March 19, 2018 - Vitl Life Science Solutions announces launch of new Lu-mini at analytica 2018
March 19, 2018 - ObsEva SA Reports Positive Topline Results from IMPLANT2 Phase 3 Clinical Trial of Nolasiban in IVF
March 19, 2018 - D.C. Week: States Plead for Federal $$ in Opioid Fight
March 19, 2018 - Polycystic ovary syndrome – Genetics Home Reference
March 19, 2018 - Reducing co-payments improves patient, physician adherence to guideline-recommended treatment post-MI
March 19, 2018 - Normalizing estrogen levels can benefit female athletes with irregular menstrual periods
March 19, 2018 - Fitness trackers and virtual coaches motivate patients to exercise post cardiac rehab
March 19, 2018 - Atrial fibrillation patients could reduce risk of dementia by taking stroke prevention drugs
March 19, 2018 - Low sperm count more prevalent with other health problems finds study
March 19, 2018 - Male birth control pill taken once a day shows success
March 19, 2018 - AcelRx Announces Receipt of Type A FDA Meeting Minutes and Plans to Resubmit the DSUVIA New Drug Application in Q2 2018
March 19, 2018 - Eye Docs Adopt EHRs Despite Reservations
March 19, 2018 - CRISPR enhances cancer immunotherapy
March 19, 2018 - Study finds first evidence of delayed aging among Americans
March 19, 2018 - Aussies unaware of sun protection rules to prevent skin cancer
March 19, 2018 - Essential oils linked to abnormal breast development in boys
March 19, 2018 - ‘Tummy Tuck’ Relieved Postpartum Back Pain/Incontinence
Trump administration rule paves way for association health plans

Trump administration rule paves way for association health plans

image_pdfDownload PDFimage_print

The Department of Labor on Thursday released proposed new rules that proponents say will make it easier for businesses to band together in “associations” to buy health insurance.

These rules, supporters say, will lead to more affordable choices for some small businesses and sole proprietors, likely starting in 2019.

Association coverage “should be cheaper and arguably just as comprehensive” as what many employers can now buy, said Christopher Condeluci, a Washington, D.C., attorney who specializes in employee benefits and has served as the tax and benefits counsel to the U.S. Senate Finance Committee.

Critics, though, are wary about whether the plans will provide consumers adequate protection.

“This approach allows associations to offer coverage that doesn’t have to come into compliance with all the critical consumer protections that would otherwise apply to small employers and individuals. It might not be as comprehensive,” said Kevin Lucia, project director at Georgetown University’s Health Policy Institute.

The proposal — which now faces a 60-day comment period — broadens the definition of those eligible to join or form such groups and rolls back some restrictions on association health plans set by the Obama administration.

Specifically, the rule would allow associations to be created for the sole purpose of offering insurance to members. In some cases, such associations could have members nationwide, making the insurance available across state lines.

For the first time, the rules would allow sole proprietors with no employees to join such group coverage.

Critics fear the rules could expose consumers to coverage gaps or higher out-of-pocket costs because these plans would be classified as “large-group plans,” so they would not have to meet some ACA rules.

For example, associations would not have to include benefits across 10 broad “essential” categories of care, including hospitalization, prescription drugs and emergency care. Under the ACA, large employers were exempt from these requirements because most already met them.

They would also be exempt from an ACA rule requiring insurers to spend at least 80 percent of premium revenue on medical care.

Georgetown’s Lucia and other policy experts warned that if plan eligibility is broadened and the plans are granted exemptions from some of the ACA’s coverage rules, they might siphon off the healthiest consumers. The result could drive up costs for small employers or individuals who buy insurance through the ACA market.

The National Association of Insurance Commissioners, for example, has previously warned that such plans “threaten the stability of the small group market” and “provide inadequate benefits and insufficient protection to consumers.”

Actuaries have made similar arguments.

Still, many ACA rules would apply to association plans, noted Condeluci. For example, plans could not reject employers based on the health status of their workers. And individual employees in a workplace could not be charged different amounts based on their health.

State authority over such plans would vary depending on whether the plans were self-insured, which exempts them from some state coverage and benefit rules, or fully insured, which means they must meet state mandates.

No matter how plans are funded, states would retain oversight of their solvency, said Condeluci.

But the proposal asks for additional comments on state regulatory authority.

States have historically had this oversight responsibility and maintained that they are best attuned to problems, concerns and consumer needs within their borders.

Whether the rule recognizes the importance of this role is a “big concern,” said Lucia. “The extent of state authority over these arrangements appears to be an evolving question for the Department of Labor.”

A GOP Go-To Health Policy

Republicans have long favored association health plans, seeing them as a way for small groups to get more clout with insurers.

One big proponent is Sen. Rand Paul (R-Ky.), who in October hinted that the Trump administration would soon move to expand access to such plans.

These plans have been around for decades, although enrollment has been more limited since the ACA’s passage. While some have worked well for their members, others have a checkered history.

A number have had solvency problems that left consumers on the hook for unpaid medical bills, while others have been fined for misleading advertising or failing to pay benefits.

Just this April, for example, Massachusetts regulators settled with Kansas-based Unified Life Insurance Company, which agreed to pay $2.9 million to resolve allegations that it engaged in deceptive practices, such as claiming it covered services that it did not.

The coverage “was sold across state lines and was issued through a third-party association,” according to a release from the Massachusetts attorney general’s office.

Other Key Elements

The proposed rule from the Trump administration would expand the definition of who can form and join an association.

It would allow associations to form for the sole purpose of offering insurance and enroll members from the same industry or region. “A plan could serve employers in a state, city, county, or a multi-state metro area, or it could serve all the businesses in a particular industry nationwide,” said the Department of Labor’s press release on the proposed rule.

Many such trade organizations pushed for looser rules.

“The National Restaurant Association applauds the administration for supporting healthcare options for small businesses to allow them to pool their resources to provide healthcare for their employees,” wrote Clinton Wolf, senior vice president for health insurance at the National Restaurant Association, in an emailed statement.

In allowing sole proprietors to enroll in association health plans, the proposal notes it would require such enrollees to actually be involved in an ongoing business, not merely offer a “single on-demand ride for a fee, or knitting a single scarf to be offered for sale on the Internet.”

“The rule is intended to cover genuine employment-based relationships, not to provide cover for the marketing of individual insurance masquerading as employment-based coverage,” the proposed rule says.

Kaiser Health NewsThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles