While President Donald Trump insisted an executive order he signed Oct. 12 would provide "great, great" healthcare to "millions and millions" of Americans, several medical and other organizations were skeptical, expressing opposition to the action.
The order is aimed at expanding the use of and lifting restrictions on association health plans, or AHPs, short-term medical insurance and health reimbursement accounts.
But Trump must rely on his agency chiefs at the Departments of Health and Human Services, Labor and Treasury to write regulations and put them in place — a process that could take several months, if not a year or longer, White House officials acknowledged.
Trump signed the order after the Republican-controlled Congress had failed to pass legislation to repeal the Affordable Care Act, or ACA — President Barack Obama's signature legislative achievement, signed into law in March 2010.
Under Trump's order, small businesses or other groups would be allowed to pool together to use their consolidated buying power under AHPs to negotiate with insurers for coverage.
The order also would lift the three-month restriction on short-term insurance, allowing insurers to offer those plans, which generally provide minimal coverage, for up to a year.
It would also allow employers to make broader use of health reimbursement accounts, which permit companies to set aside pretax dollars for employees to buy coverage outside of the ACA's rules.
Sen. Rand Paul, R-Ky. — one of three senators who had opposed the latest attempt in the Senate to repeal and replace the ACA — called Trump's executive order the "biggest free-market reform of healthcare in a generation."
But several groups warned Trump's proposed actions could leave Americans without the protections that federal and state regulations offer.
Opening up the much cheaper, but riskier, short-term plans would siphon off younger, healthier Americans from the individual market, leaving those with chronic or serious illnesses in an unsustainable insurance pool, resulting in fewer choices and higher premiums for the latter group, a faction of nearly 20 healthcare organizations, including the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Heart Association and March of Dimes, said in a joint statement.
Under the short-term plans, insurers could deny coverage to Americans with pre-existing conditions, the healthcare groups pointed out.
They noted that the AHPs would be exempt from including the ACA-required essential health benefits, such as preventive care, prescription drugs and hospitalization, and Americans could again face annual or lifetime coverage caps.
Unintended and far-reaching consequences
The American Academy of Actuaries expressed similar concerns about short-term plans and AHPs.
Uncertain or conflicting rules about AHP solvency requirements could create conditions where bankruptcies result, leaving consumers without coverage and with few avenues for redress, the actuaries group said in a statement.
With no defining regulatory framework for AHPs, there could be uncertainty as to whether consumer protection laws apply to Americans enrolled in those types of plans, they said.
"It's important that AHPs and short-term plans not serve as a workaround of federal and state insurance rules and protections that have been created to benefit consumers," said Cori Uccello, a senior health fellow at the actuaries group.
Trump's order could present significant risks and have unintended and far-reaching consequences for consumers and health insurance markets, Uccello warned.
To avoid those adverse outcomes, the risks and consequences for consumers and insurers need to be well understood and addressed before the HHS, Labor and Treasury departments issue any regulations under Trump's order, she said.
While America's Health Insurance Plans, the largest Washington lobbying group for insurers, did not specifically address Trump's action, it said Americans, including those with pre-existing conditions, should have access to affordable coverage and care.
"We believe that reforms must stabilize the individual market for lower costs, higher consumer satisfaction and better health outcomes for everyone," Kristine Grow, the group's senior vice president of communications, said in a statement.
"We believe we cannot jeopardize the stability of other markets that provide coverage for hundreds of millions of Americans."
Nothing written in stone yet
The National Association of Insurance Commissioners, or NAIC, said it welcomed and supported returning to state regulators the authority and market oversight of short-term plans, but it was concerned about expanding AHPs "in a manner that reduces consumer protections or solvency requirements that promote safe and sound markets."
The commissioners group said it also had concerns about the impact of that proposal on already fragile markets.
But NAIC CEO Mike Consedine noted that "nothing is written in stone yet," and his group would engage with federal officials "to make sure they understand our concerns, which are focused on consumer protection and solvency."
"We share the objectives of accessible, affordable healthcare," Consedine said in a video statement posted on Twitter. "We just want to make sure that these policies achieve that and don't further destabilize an already unsteady marketplace."