Last Thursday afternoon, the Trump administration released its final rule regarding Health Reimbursement Arrangements (HRAs). The 497-page document will take lawyers and employment professionals weeks to absorb and digest fully. But in a nutshell, the rule will help to make coverage more portable and affordable—while also going a long way to resolve the problem of pre-existing conditions.
In an ideal world, most people would own their own health insurance and take it with them as they travel from job to job and in and out of the labor market. Some employers may have better insurance than people can find in the open market. But most employers would prefer to make a cash contribution to help employees pay their own premiums rather than provide insurance directly.
When President Trump took office, small businesses and hard-working, middle-class families were finding it increasingly difficult to afford health insurance. The Trump administration already has taken significant steps to help, and Thursday it took another one. A new Trump administration rule will provide an estimated 800,000 businesses a better way to offer coverage and give millions of workers new ways to obtain coverage through the expansion of Health Reimbursement Arrangements (HRAs).
The Trump administration’s new HRA rule undoes an Obama administration action that forbade workers from using HRA funds to purchase health insurance policies offered outside their workplace. “President Trump’s new rule undoes this misguided restriction” that reduced choices for workers and especially for small businesses, White House economist Brian Blase explains. The new accounts have the potential to be transformative, much as 401(k)s were for retiree benefits, giving employees more control and portability with their health coverage.
President Trump is expected to issue an executive order soon that could require insurers and hospitals to disclose the prices they’ve negotiated for various services. He hopes such transparency will increase competition and drive down health spending.
The health care industry is less supportive. The nation’s top health insurance lobby, for instance, claims the president’s plan is “bad transparency” that could actually cause prices to go up.
| Last week the Trump Administration rolled out a semiannual summation of all the administration’s regulatory activity. Noteworthy for health policy observers, the administration has pushed back to November finalization of the proposed rule on manufacturer rebates for drugs purchased through the Medicare Part D and Medicaid Managed Care program. Opposition to the proposed rule has focused on the potential increase in costs to the federal government. It is important, however, to recognize just how uncertain the myriad cost analyses of this proposed rule are. AAF recently reviewed six cost estimates in detail here, but the key takeaway is that the numbers produced by these estimates depend greatly on behavioral responses that are enormously hard to predict correctly. |
The Centers for Medicare & Medicaid Services will take more time to judge the performance of navigator groups tasked with ACA enrollment outreach, the agency said Thursday. Performance is tied to funding. Starting in the 2020 open-enrollment period, navigator groups will be evaluated on a two-year performance period rather than one year. Federal funding is tied to how many people are signed up by the groups. The CMS said the change will help stabilize the program and improve consumers’ experience.
| HHS Secretary Alex Azar has been almost singularly focused in delivering on the administration’s promises to increase transparency and lower prescription drug prices since President Trump released his American Patients First blueprint in a Rose Garden ceremony a year ago. The blueprint offered nearly 30 policy recommendations to modernize payment policies, including bringing down out-of-pocket costs for patients. Just last week, HHS issued a final rule to give patients and doctors more tools to monitor and control costs in Medicare. For example, after a start-up period, Medicare Part D plans will be required to provide doctors and other prescribers access to price information for different prescription drugs when they are writing the script. |
| Short-Term Limited-Duration Insurance (STLDI), which is exempt from ACA rules, survived as a viable competitive market, offering health coverage priced in proportion to individuals’ risks. But it has been disparaged as “junk insurance” that fails to cover adequate provider networks, offers only catastrophic coverage, makes essential benefits unavailable, helps only young and healthy individuals, undermines protections for those with preexisting conditions, and causes premiums for plans on the ACA’s exchange to soar. This study of the STLDI market finds that each of these claims is false. For equivalent insurance protection, the premiums for STLDI plans are lower than—in some cases, almost half the cost of—premiums on the exchange. The savings to be gained from switching to STLDI are even greater for more comprehensive insurance coverage. |
The Trump administration has been working behind the scenes for months on a strategy to force greater price disclosure across much of the $3.5 trillion health-care industry. The push relies on existing administrative tools, according to people familiar with the discussions. Those include Labor Department powers under the law setting minimum standards for private-industry health plans and current hospital-payment rules under Medicare. The administration is strongly interested in forcing insurers to publicize the negotiated rates they pay for services, the people said. The requirement could affect insurers providing coverage in the private-employer market.