Healthcare reform is a topic that continues to dominate the news. This article provides background on the current situation, what the AIA Trust now offers to AIA members and its future plans.
The Affordable Care Act (ACA) was passed into law in 2010 with various components becoming effective over each of the succeeding years. The ACA requires most citizens to have health insurance while also creating exchanges where individuals and small businesses (up to 100 lives) could purchase insurance. All plans in both the individual and small group markets are required to have specific essential benefits, no lifetime maximum, and limits on annual cost-sharing. While the number of uninsured has decreased since the ACA became law, many insurance carriers have indicated that they are exiting some or all markets because of the resulting losses that they’ve incurred.
Some insurance companies have recently announced complete withdrawals from the exchanges while others have reduced the number of counties where they will sell 2018 plans. This varies by insurance company and by state but some states such as Ohio, Tennessee and Iowa have been hit especially hard. As of now, 49 counties are projected to have zero exchange plans and up to 1300 counties nationwide may have only one plan; however, these are mainly in rural, less populated locations. Click here for a map showing currently projected 2018 insurer participation by county in health insurance exchanges.
The ACA specifically excludes membership associations as permissible groups and requires that the individual market rules apply to membership associations. Therefore, the AIA Trust is not permitted to negotiate customized health insurance policies under current law.
The AIA Trust continuously monitors the health insurance market in order to provide members with access to the exchange plans. Working with their advisors, the AIA Trust reviews, researches and interviews services that offer health insurance to individuals and small groups. However, unlike other member benefit products, the AIA Trust cannot negotiate rates and/or benefits for the health insurance plans as these are defined by the provisions of the ACA under the supervision of insurance regulators. Through the course of AIA Trust due diligence, the Trustees have selected services that via technology offer as many options as feasible to members to compare various offerings in their respective locations.
Negotiations are now underway in Congress to change the ACA, with the House and Senate looking at alternative plans. As of this writing, the House has passed their version while the Senate has released a draft. If the Senate passes their version, the differences must be negotiated between the two bodies.
Both versions under discussion would eliminate the individual and employer mandates, end Medicaid expansion, permit states to waive essential health benefit requirements and repeal a number of taxes. In addition, the proposals will encourage the use of Health Savings Accounts while keeping popular provisions such as permitting dependents to remain on plans until age 26. The Senate version also establishes federal certification of small group association health plans, called “small business health plans”. It is unclear if such changes will become law and what the final parameters might entail.
Note that Health and Human Services has formalized one change regarding the 2018 open enrollment period. The open enrollment period has been cut in half to 45 days and begins November 1, 2017 running through December 15, 2018.
The AIA Trust is actively tracking these negotiations so that in the event more attractive options become available, the Trustees will assess new offerings to make viable ones available to AIA members.