Senate Democrats on Thursday criticized the Trump administration’s proposed rule to allow “junk health plans” with high deductibles and limited coverage to be sold on Affordable Care Act (ACA) health insurance exchanges.
“President Trump told the American people he would save them from the ‘big, fat, rich insurance companies that have made trillions and robbed America for too long,'” the 16 senators wrote. in a letter To CMS Administrator Mehmet Oz, MD, MBA. “Instead of keeping this promise, this administration has proposed a rule that CMS’s own experts estimate would deprive 2 million Americans of the health care they deserve and accelerate the health care affordability crisis. In short, this proposed rule is just another handout for the insurance industry and profit-seeking middlemen.”
Below proposed rules The letter says CMS’ plans, released Feb. 6, could lead to disastrous health plans selling “with extremely high deductibles and out-of-pocket costs.” The rule also suggests loosening network requirements for plans, and proposes that insurers be allowed to offer “non-network” plans — plans without a specific network of contracted providers — that Democrats say may not cover the cost of care.
In the proposed rule, CMS said it would allow plans that show they can ensure “adequate” choice of providers that “Accept the benefit amount of the non-network plan as full payment.However, “While enrollees in a non-network plan may receive some benefits for covered services from virtually any provider, there is no guarantee that the plan’s benefit amount is actually sufficient to cover the provider’s full charges,” and providers are not required to accept the plan’s benefit amount as full payment.
“As a result, non-network plans may leave enrollees with additional out-of-pocket expenses, making some providers unavailable as a practical matter,” CMS said.
As far as how many people will enroll in these new catastrophic or non-network plans, CMS says in the rule that it estimates “average enrollment for 2027 will decline between 1.2 and 2 million enrollees compared to the baseline estimate. Many enrollees will lose coverage by no longer being eligible for subsidies, and we believe it is likely that healthy enrollees will be more likely to drop coverage.”
The proposed rule also anticipates a 2% to 3% increase in premiums in light of several changes; However, CMS said, various other rule provisions would get rid of the opportunities for adverse selection, meaning fewer sick people would enroll in ACA exchange plans and premiums would actually decline by the estimated 1.5% to 1.8%.
In their letter, the Democratic senators, including Senate Majority Leader Chuck Schumer (D-N.Y.), Senate Finance Committee Ranking Member Ron Wyden (D-Ore.), and Senate Appropriations Committee Vice Chairwoman Tammy Baldwin (D-Wis.), said the proposed rules would “increase out-of-pocket costs for insurers, sell new types of junk insurance coverage, increase deductibles for working families, cover fewer services and more.” “Will make it easier to kick providers out of the network.”
The letter also notes that the proposed rule would allow states to replace their ACA insurance marketplaces with “a system of profitable web-brokers” who can take advantage of potential enrollees’ personal information to promote “junk coverage” and would not require potential enrollees to tell whether they are eligible for Medicaid. He said the system would “make it harder for consumers to make apples-to-apples comparisons between all the available plans”.
He said, “Our healthcare system already favors profits for big corporations more than providing healthcare to all people.” “Handing over more of the health care system to for-profit middlemen directly contradicts the President’s commitment to putting American patients ahead of the interests of for-profit corporations.”
The senators concluded, “The Republican health care crisis has already put health care even further out of reach for millions of Americans… CMS should withdraw this harmful rule and re-propose an annual ACA rule that works to reduce out-of-pocket costs and put patients’ interests above those of the insurance industry.”
