Perspective: The Importance of Comprehensive Coverage

Health insurance markets thrive on stability. Rates and policies are set months in advance of a plan year and dozens, upon dozens of calculations and considerations go into them.

We have seen what uncertainty can do to health insurance markets. In the early years of the marketplaces, health plans faced a lot of unknowns – who and how many people would enroll, and their health care needs. Their interest in selling plans – and what they would charge for them – was volatile from one year to the next. However, with a few years of experience, those questions were addressed, and markets began to stabilize.

This year, more health plans are signing up to sell coverage and, in some markets, at lower rates than last year. 

But now, the marketplaces face another form of instability: whether government rules will stay as they are or change. Recently, the administration expanded the availability of less comprehensive association and short-term, limited-duration health plans. Then, this week, the administration introduced several other potentially disruptive policies. They loosened the rules around the use of 1332 waivers to allow states to opt out of certain requirements related to the comprehensiveness and affordability of coverage, and proposed to allow employers to move some or all of their employees into the individual market using health reimbursement arrangements. All of this comes on top of remaining concerns about whether and how the government will reimburse insurers for reducing the co-pays and deductibles of low-income consumers. 

Many of these policies could renew health plan fears of low enrollment and a high concentration of individuals with significant health care needs. Volatility in health plan participation and premium rates could return. 

In addition, the types of health plans being advanced through these policies, especially the short-term plans, are high risk for patients. They may appear cheaper, and thus more attractive to younger, healthier consumers, up front. But, ultimately, they put a patient’s health and financial security at risk because of their skimpy coverage — many fail to cover pre-existing conditions or other critical services. That is one reason we oppose expanding access to these plans and why we strongly encourage individuals to carefully evaluate their potential health care needs when selecting coverage.  

Open enrollment on the marketplaces begins on Nov. 1 for 2019 coverage and runs through Dec. 15, and America’s hospitals and health systems have a vital role to play in connecting consumers with health coverage. See our webpage for resources to help you engage with members of your community.