4 Most Misunderstood Changes To U.S. Health Care In 2018

NASHVILLE  -- While the American health care landscape continued to evolve in 2018, some of the most significant changes were also those most prone to misunderstanding or misinterpretation. Health policy expert Kev Coleman, president and founder of AssociationHealthPlans.com, offers his picks for the most misunderstood changes in health care this year.

1. The Impact of Eliminating the Individual Mandate

Despite concerns about a catastrophic effect on Affordable Care Act enrollment, eliminating the individual mandate is unlikely to cause a large portion of enrollees to abandon ACA coverage. That's because the vast majority of government exchange enrollees (83 percent in 2018) receive subsidies that dramatically reduce their costs. HealthCare.gov consumers receiving tax credits paid an average monthly premium of $89, as opposed to the unsubsidized average of $621.

"If you look at the numbers, it's very unlikely people receiving subsidies will abandon ACA coverage, even without the individual mandate," Coleman said. "However, for the 17 percent of exchange enrollees who are unsubsidized, the removal of the individual mandate combined with the cost of exchange insurance will reduce enrollment.”

2. The Trump Administration Plan for Lowering Drug Costs

When the Trump administration unveiled a blueprint in May for lowering what Americans pay for prescription medications, there was some confusion and concern that all the proposals are set in stone. However, the proposals contained in the blueprint are not guaranteed to be fulfilled. In fact, the various initiatives within the blueprint fall into two categories: actions the president may direct Health & Human Services (HHS) to pursue, and actions HHS is actively considering.

"The scope of the blueprint indicates that the Trump administration is not counting on a single strategy to decrease drug costs but experimenting with a variety of measures, any one of which may be unsuccessful or fail to be implemented," Coleman said. "This broader approach reduces the chance of special interest groups derailing the initiative as a whole.”

3. Reversing the Three-Month Coverage Limit for Short-Term Health Plans

While the reversal of the three-month restriction in October of 2018 garnered considerable press attention, more significant was the attendant change that allowed states to permit short-term plan renewals or extensions for up to 36 months (without any medical underwriting or experience rating past the initial sale of the policy).

"Within states that choose to adopt the 36-month provision, we may see new short-term benefit configurations since the longer duration changes the economics of these plans for insurers," Coleman said. "Practically, this may mean additional benefits in some plans or even limited pre- existing condition coverage.”

4. New Association Health Plan Regulation

A June 2018 regulation redefined the conditions under which associations can form and also opened up association health plans to the self-employed and gig economy workers. The same regulation introduced multiple measures to discourage fraud and mismanagement among these plans. Critics of this new rule have predicted that associations will offer "skinny benefit" plans. In reality, large group association plans are still subject to state benefit rules as well as numerous federal benefit requirements relating to issues such as maternity care, pre-existing condition coverage and preventive care.

"Since the new regulation on association health plans has many facets, many health care insiders are still learning how benefit requirements are determined by an association's size, state of residence and whether the plan is self-insured or insured through a third-party company," Coleman said. "As more association plans are launched in coming years, understanding of their mechanics will improve.”