As APTA continues to advocate for the maintenance of essential health benefits (EHBs) in insurance offered through Affordable Care Act (ACA) marketplaces, the association and other stakeholders are facing another potential challenge to patient access to care: private insurer short-term, temporary health plans that can skirt many ACA requirements around EHBs, preexisting conditions, and continued coverage.
Earlier this month, the Department of Health and Human Services (HHS) adopted a final rule on the short-term plans, allowing the policies to provide 1 year of coverage, renewable for up to 3 years. Previously, the plans could only be used for a maximum of 3 months.
The plans are intended to offer a cheaper insurance alternative than plans available through the ACA (although most individuals who purchase insurance through the ACA marketplaces receive subsidies that lower the out-of-pocket costs). But they are not required to comply with many of the consumer protections included in ACA plans. Instead, the plans are able to deny coverage of a preexisting condition, drop coverage should a customer's health status change, and refuse coverage for services such as mental health, prescription drugs—and, possibly, physical therapy.
"These plans create more options, but they also create more uncertainty for patients and physical therapists," said Kate Gilliard, APTA regulatory affairs senior specialist. "We're concerned that, perhaps unknowingly, patients who purchase these plans may be moving onto plans that don't cover physical therapy or that offer very limited physical therapy benefits."
Gilliard said the short-term plans were a hot topic at a recent National Association of Insurance Commissioners (NAIC) conference she attended as a representative of APTA.
"The plans received mixed reviews from the commissioners," Gilliard said. "Some states openly thanked HHS for allowing more consumer options and for giving states more control over their own markets, but other states criticized the plans for the weaker consumer protections and predicted that the plans will cause prices in the ACA marketplace to rise." According to Gilliard, NAIC attendees described a variety of approaches being taken by states in reaction to the HHS rule, from accepting the provisions as written, to placing shorter time limits on coverage, to banning the plans completely.
"Many of these states are trying to frame these plans as options that should only be used when consumers are in between major medical plans—like when they are between jobs or waiting for ACA marketplace open enrollment—and not to be relied upon as real, full health insurance," Gilliard said.
APTA regulatory affairs staff are reviewing the rule to better understand potential impacts to patients and the physical therapy profession. However, the association has already gone on record in support of consistent EHBs and has voiced its opposition to an HHS rule change that allows states to lower the bar on required EHB coverage provisions in so-called "benchmark" plans that set the floor for coverage offered in a state marketplace. Many of the short-term plans are even skimpier than what's being offered through the ACA exchanges, even with the recent benchmark changes.
"While APTA has always supported the importance of patient choice in health care, we are also committed to advocating for access to needed care and consumer certainty that the care patients receive today will be there tomorrow," said Kara Gainer, APTA's director of regulatory affairs. "Short-term plans offer choice but run the risk of decreasing access and creating uncertainty, and the recent final rule from HHS would appear to make matters worse."