Slowly but surely, President Biden is repairing the U.S. health-care system, reversing Trump-era sabotage and ensuring millions more Americans get access to affordable coverage.

The latest of these efforts came on Friday, in a little-noticed but significant decision to protect Americans from junk health insurance.

In 2017, Congress repeatedly tried and failed to repeal the Affordable Care Act. To casual observers, it might have looked like the end of the Republican fight to kill this lifesaving, inequality-fighting, newly popular law. It wasn’t. Over the next few years, President Donald Trump found new ways to sabotage the health-care system and its protections for the most vulnerable Americans.

Among the most insidious of these backdoor repeal measures: expanding “short-term, limited duration” health plans — i.e., attempting to trick Americans into plans that looked cheap but basically covered nothing.

Short-term plans are theoretically intended as brief, stopgap coverage — say, to tide over a new college grad whose job doesn’t start until the fall.

They’re relatively unregulated; they don’t have to cover minimum care benefits guaranteed by Obamacare and other major legislation, for example. A 2018 analysis found that most don’t cover maternity services, substance-abuse care or prescription drugs.

These plans can also deny coverage for care of preexisting conditions, even if the preexisting condition in question hadn’t yet been diagnosed at the time the person enrolled.

People often don’t realize they’ve bought a worthless product until it’s too late — when they get hit by a bus, say, or are diagnosed with a brain tumor.

Such loopholes might seem like no big deal until you find yourself falling through one. The Trump administration made sure more people did by allowing these allegedly short-term plans to last as long as 364 days, rather than the three-month max that had been in place, and to be renewed for up to three years.

This made them look a whole lot like regular plans. Plus, because short-term plans are mega-profitable for insurers, brokers can get much larger commissions for steering hapless customers into them. So, many did.

Exactly how many were lured by this policy change is unclear; the data is lousy, precisely because these products are so unregulated. A recent estimate from the Urban Institute ballparked the number of people enrolled in individual plans that are noncompliant with Obamacare protections at 2.5 million.

The proliferation of short-term junk plans affects even consumers who don’t get duped by them. That’s because these cheaper plans disproportionately siphon healthier (i.e., lower-cost) people out of the broader individual insurance marketplaces. People who have chronic conditions or otherwise know they will need more substantial coverage are more likely to stay in the regular marketplace pool, driving premiums there ever higher.

Last week, however, the Biden administration announced a rollback of this Trump-era expansion of short-term health plans.

In a proposed rule, Biden officials said those already in these skimpy Trump-blessed plans can continue in them, if they so choose. (“There were some hard lessons learned from the ‘if you like your plan you can keep it’ blowback a decade ago,” surmises Georgetown University health scholar Sabrina Corlette.) But going forward, any new “short-term, limited duration” plans would need to be truly short-term (up to three months) and truly limited-duration (renewed for up to one additional month only).

Critically, short-term plans must also provide clearer language about what care they do and don’t cover, and under what circumstances. People who choose to buy junk must know upfront that they’re buying junk.

The White House has marketed this rule as part of “Bidenomics,” though it might be more easily understood as simply pro-consumer. It also dovetails nicely with other actions the administration has taken to expand access to coverage, including outreach to encourage eligible Americans to enroll in marketplace plans and patching the so-called family glitch (a regulatory accident that had blocked a lot of families from accessing subsidized health coverage).

Most important, through last summer’s Inflation Reduction Act, Biden extended the enhanced premium tax credits available for plans on the individual marketplace.

This has meant that millions more Americans can get solid health-care coverage that not only is affordable but also, in many cases, has an out-of-pocket premium of zero dollars. And unlike with those junk insurance plans, the low price tag here isn’t a red flag; these plans actually do provide comprehensive coverage, including for people with preexisting conditions.

It’s not a bait-and-switch. It’s a real subsidy — and one that will likely drive down premiums overall, on average, by drawing more healthy people into the broader marketplace risk pool.

Our health-care system is still kludgy. It still allows too many Americans to fall through the cracks. But small unsung fixes such as this are achievements worth celebrating.

  • WarmSoda@lemm.ee
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    1 year ago

    Guys, if you are actually poor apply for Medicaid*. Don’t wait for something bad to happen to you or for ACA or a new bill or whatever. Just apply. Even if you don’t think you’re eligible apply anyways. You’d be surprised.

    It covers a shit ton of stuff, including meds. Eye, dental, hospital visits, primary Dr. All covered.

      • UnstuckinTime@lemmy.world
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        1 year ago

        Yeah and I think Medicaid actually is a much more simple plan because there was no donut hole or supplemental offerings. People on Medicare tend to still have way higher liability for prescription drug coverage.

        Which is silly, they have privatized Medicare so much that it’s ridiculously complicated. And servicing government contracts for Medicaid and Medicare have become a huge growth area which is why HMOs supported Medicaid expansion.

        What we should do is simplify Medicare to make it more like Medicaid in terms of no deductibles, no donut hole, but then just eliminate the age bracket. Automatically opt everybody in…

        Preferably that would be the end of it but if you absolutely had to have like a German type system if someone wanted to opt out they would have to demonstrate their ability to afford private care but that’s a much less efficient way. But it’s still better than the US model.

        I mean literally we could make a map of the 35 OECD Nations and throw a dart at it and wherever it lands it would be a better system than what the US has.

    • UnstuckinTime@lemmy.world
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      1 year ago

      Basically if you live in an expansion state you’re eligible if you make less than 128% of the poverty level. Which is about $16,000 a year for a single adult. If you don’t live in an expansion state your mileage may vary. There was a buffer during the covid emergency stage where states were a little more generous like Texas than they would otherwise have been.

      But Texas in particular at one point kicked you off Medicaid if you made even like 6K a year. They were only supporting people that made less than 25% of the FPL. Certainly not 128%. I think all but 16 states at least now extend to that