Little reassurance seen in insurance rules; Nearly every health care group cites potential problems

WASHINGTON - More than 95 percent of health care groups that have commented on President Donald Trump's effort to weaken Obama-era health insurance rules criticized or outright opposed the proposals, according to a Los Angeles Times review of thousands of official comment letters filed with federal agencies.

The one-sided outpouring came from more than 300 patient and consumer advocates, physician and nurse organizations, and trade groups representing hospitals, clinics and health insurers across the country, the review found.

Kris Haltmeyer, vice president of health policy and analysis at the Blue Cross Blue Shield Association., said he couldn't recall a similar show of opposition in his more than 22 years at the trade group, which represents Blue Cross and Blue Shield health plans and is among the organizations that have expressed serious reservations about the administration's proposed regulations.

"This seems to be a pretty overwhelming statement of concern," Haltmeyer said.

State insurance regulators from both political parties have also warned that the administration's proposals could destabilize insurance markets, raise premiums for sick Americans and open the door to insurance fraud.

Dozens of industry leaders and other experts have called on the administration to rethink moves to scale back consumer protections enacted through the Affordable Care Act, often called Obamacare.

"Basically, anybody who knows anything about health care is opposed to these proposals," said Sandy Praeger, a former Republican state insurance regulator in Kansas and onetime president of the National Association of Insurance Commissioners. "It's amazing."

After the failure to repeal the health care law last year, the Trump administration is weighing two controversial new rules to loosen regulations governing health plans.

One would expand the availability of short-term coverage plans that last less than a year. The other would make it easier for self-employed Americans and small businesses to band together to form association health plans.

These plans - which administration officials say will be more affordable - would not have to offer the full set of health benefits required under the 2010 law and in some cases could turn away sick customers.

Altogether, more than 95 percent - or 266 of 279 - of the health care groups that filed comments about the proposed association health plan regulation expressed serious concern or opposed it, the Times analysis found.

More than 98 percent - or 335 of 340 - of the health care groups that commented on the proposal to loosen restrictions on short-term health plans criticized it, in many cases warning that the rule could hurt sick patients.

"As advocates for our communities, we implore you to protect patients and consumers, including individuals with preexisting conditions and persons with disabilities," a coalition of 106 groups noted in one letter urging the administration to withdraw the proposal.

Among the groups were virtually every leading patient advocate in the county, including the American Lung Association, the American Heart Association, the Cystic Fibrosis Foundation, the March of Dimes, the National Multiple Sclerosis Society, Susan G. Komen, AARP and the advocacy arm of the American Cancer Society.

Not a single group representing patients, physicians, nurses or hospitals voiced support in the public comments for the two Trump administration proposals.

Before finalizing proposed regulations, federal agencies typically provide a comment period during which individuals and interest groups can share their opinions. Comment letters are then posted on an agency's website or on regulations.gov.

A total of 722 comments were posted by the Department of Labor on the administration's association health plan rule; 9,205 were posted on the proposed short-term health plan rule.

Most of the comments were from individual Americans, many of whom shared concerns about access to health coverage. The Times identified comments from health care groups to gauge the opinions of experts who work in the system or advocate for patients.

Officials from 25 states - including insurance regulators, attorneys general and insurance marketplace directors - also submitted comments. Most were critical, with the exception of insurance officials from six states who welcomed one or both of the administration proposals.

Several dozen individual health care businesses, including insurers, medical systems and benefit consultants, filed comments on the two proposals, offering more mixed views.

Administration officials have said relaxing regulations and allowing more health plans that offer limited benefits or that may exclude sick consumers will provide more options to people who are being priced out of the health insurance market.

"We want people to have access to competitive, affordable health insurance," Health and Human Services Secretary Alex Azar told lawmakers on Capitol Hill recently. "Unfortunately, the Affordable Care Act is not delivering on that."

The health care law has helped expand coverage to some 20 million previously uninsured Americans, through the expansion of state Medicaid programs for the poor and through new marketplaces that offer subsidized health plans for low- and moderate-income people who don't get coverage through an employer.

But the marketplace plans - which must offer a basic set of health benefits and cannot turn away sick consumers - have become more expensive, as premiums that began to rise under President Barack Obama have shot up under the current administration.

That has made coverage unaffordable for the small share of Americans - perhaps as many as 15 million - who don't receive coverage from their employers or from a government plan and make too much to qualify for federal marketplace subsidies.

The subsidies cut off after about $48,000 for an individual and $100,000 for a family of four.

The Trump administration's proposals may make some insurance more affordable, largely by allowing plans to skip mandated benefits, such as prescription drugs, maternity care, mental health and addiction services.

Short-term plans - which are limited to three months but which the administration wants to extend to a year - could also be allowed to turn away sick people. That would allow them to charge lower rates.

noam.levey@latimes.com

Credit: By Noam N. Levey - Washington Bureau - noam.levey@latimes.com

Caption: The Trump administration is weighing two controversial new rules to loosen regulations governing health plans.

J. Scott Applewhite/AP