Affordable Care Act
Published on October 29, 2018
Trumpcare for 2019
The Trump administration has made three attempts to reform, replace, or augment the Affordable Care Act (ACA or Obamacare).
|Round 1 (Past)||Round 2 (Present)||Round 3 (Future)|
|The American Healthcare Act||Extended Duration Short-Term Health Plans||Association Health Plans & Health Savings Account Expansions|
The American Healthcare Act – The Past (July 27, 2017)
The term “Trumpcare” started out as a nickname for the American Health Care Act (AHCA). The AHCA was a replacement plan for the Affordable Care Act (ACA or Obamacare).
The U.S. House of Representatives passed the AHCA, but the U.S. Senate’s version of the bill didn’t get enough votes. Former U.S. Senator, John McCain, provided the deciding “no” vote on July 27, 2017.
Without the support of the majority of the United States Senate, the bill never made it to the President’s desk to be signed it into law. More detail on the AHCA is available here, or at the bottom of this page.
Short-Term Health Insurance Plans – The Present Version of Trumpcare (August 1, 2018)
On August 1, 2018 the Centers for Medicare and Medicaid Services (CMS) changed rules that govern short-term, limited duration(STLD) health insurance plans. CMS made it possible for people to stay on a short-term health plan for to up to 364 days. That rule change became effective on October 1, 2018.
This change reversed a 2017 Obama-era rule that limited short-term health insurance from 364 days to 90 days. The new rules also made it possible for states to allow short-term plans to be sold in their state that cover people for up to three years.
Impact on State Regulations
These changes in regulations by CMS gave states regulators more freedom to change rules governing short-term health insurance. As a result, the rule changes are being implemented differently at the state level.
States have taken one of three approaches:
- Fast Movers: Some states allowed for the short-term plans that were already available in their state today to return to the 12 or 6-month terms they’d had in 2017.
- Slow Movers: Other states require changes to the short-term plans available in their state before they will allow those plans to cover people for more than 90-days. In these states, 90-day short-term plans may still be an option, with more options coming soon.
- No Movers: A final group of states have either banned short-term plans, or made changes to the required benefits in a short-term plan. When the required benefits change, insurance companies have to develop new plans and get them approved by the state. In those instances, short-term coverage may not be available until the new plans are approved.
Short-Term Health Insurance Options, by state, at eHealth.com
eHealth.com is a national health insurance marketplace, but it’s possible that there are short-term plans available in states that we do not have on our web site.
This image breaks down, by state, where you can buy short-term coverage and for how long you can keep a plan, at eHealth.com only.
- 26 States (& Washington D.C.) with eleven-month short-term health insurance options include: Alabama, Arkansas, Washington D.C, Delaware, Florida, Georgia, Iowa, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Nebraska, New Mexico, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, West Virginia, Wyoming
- 12 States limited to six-month short-term health insurance options include: Arizona, Colorado, Connecticut, Indiana, Michigan, Minnesota, Missouri, Nevada, Oklahoma, Utah
- 4 States limited to three-month short-term health insurance options include: Alaska, Maryland, Oregon and Washington
- One State limited to four-month short-term health insurance options: Montana
- 7 States with no short-term health insurance options include: California, Hawaii, Massachusetts, North Dakota, New Jersey, New York, Rhode Island, New Hampshire and Vermont.
In states where short-term health insurance is not an option, individuals do have the option to buy “Obamacare” or major medical health insurance. However, the high cost of these plans may leave some consumers without affordable options.
In those states, eHealth has these affordable alternatives to ACA Coverage:
|State||Guaranteed Coverage||Medical Questions Required|
|Massachusetts||Accident insurance w/office visits||No|
|New Jersey||Accident insurance w/office visits||No|
|New Hampshire||Accident insurance w/office visits||No|
|New York||Accident insurance w/office visits||No|
The Future of Trumpcare – Association Health Plans (AHPs) & Health Reimbursement Arrangements (HRAs)
Association Health Plans (AHPs)
In June of 2018, the Trump administration announced new regulations governing Association health plans. These new plans would not have to meet all of the benefit requirements required under the Affordable Care Act, like requirements to cover maternity care or mental health care.
But, they would function like major medical coverage in the sense that all medical costs would be covered, after a customer’s cost-sharing (deductibles, etc.) were met for the plan year. And, the plans would be “guaranteed-issue,” which means your application can’t be declined because you have a pre-existing condition.
Conceptually, the way this would work, is that associations would make these health plans available to their members. These associations could define their membership requirements and their health insurance plan benefit requirements, and then work with insurance companies to make the coverage available.
Buying Across State Lines
One of the perceived benefits of association health plans is that an insurance company could file a plan in a single state, get it approved in that state, and then offer “across state lines,” in multiple states.
This practice happens today with limited benefit health insurance plans offered through associations.
Health Reimbursement Arrangements (HRAs)
New rules proposed on October 23, 2018 would allow employers fund Health Reimbursement Arrangements (HRAs) for employees. In turn, employees can use that money to pay for health insurance plans they buy on their own on health insurance marketplaces like eHealth.com.
The new proposal would give state’s the authority to make these changes through state innovation waivers that were part of the Affordable Care Act (ACA or Obamacare).
The new HRAs rules aim to encourage small businesses with fewer than 50 employees to pay for health care coverage for employees. These employers are not subject to the employer requirements to the ACA’s mandate to provide coverage.
The Trump administration’s proposed rule on HRAs would give employers another way to offer financial assistance to workers who can’t afford to buy health coverage on their own.