Washington, California & Illinois: Good News & Bad News on the #ShortAssPlans Front

It's been awhile since I last updated my "ACA Protection Spreadsheet", which is an attempt to track a whole mess of bills designed to protect the Affordable Care Act from sabotage at the federal level by the Trump Administration and Congressional Republicans. My last update was over a month ago, when Hawaii's Governor signed a law which locks in several ACA protections, including:

  • Ensure that young adults can continue to remain on their parents’ health insurance plans until age 26
  • Prohibit insurers from using applicants’ gender to set premiums
  • Prohibit insurers from rejecting an application based on an applicant’s medical history, or imposing coverage exclusions based on pre-existing conditions.

Today, however, there were major developments regarding #ShortAssPlan restrictions (and a few other important patient protection bills) in three states: Two positive, one negative.


BREAKING: CA Assembly passes SB1108(@DrEdHernandez) with 50 votes, to prevent California from agreeing to Medicaid waivers that don't meet the goals of Medi-Cal, such as restricting eligibility thru barriers like work requirements. Now seeks final vote in Senate. #Care4AllCA

— Health Access CA (@healthaccess) August 27, 2018

I don't think I even knew about this one, but am glad to see it pass and hope it becomes law. The odds are slim that California would ever try and add work requirements to Medicaid anyway, but it's still a good thing to be proactive about.

BREAKING: CA Assembly passes SB1375(@DrEdHernandez), on a 47-17 vote, to limit the sale "junk insurance" through Association Health Plans (AHPs)--which have been promoted by Trump Administration & threaten to undermine California's insurance market and spike premiums. #Care4AllCA

— Health Access CA (@healthaccess) August 27, 2018

Association Health Plans (AHPs) are the "ass" part of #ShortAssPlans. They haven't gotten nearly as much attention as the "short" part (expansion of so-called "Short Term, Limited Duration" policies), a complete ban on which actually just made its way to Gov. Brown's desk a few days ago, but there are some healthcare advocacy wonks who think AHPs could actually pose an even bigger threat to the ACA market than expanded STLDs. Again, hoping this one gets signed into law as well.

BREAKING: To prevent extreme prescription drug cost-sharing, CA Assembly passes our bill #SB1021(@Scott_Wiener) on a bipartisan, 62-0 vote. Bill would extend CA patient protections on prescriptions, including those that cap co-pays at $250. #Care4AllCA

— Health Access CA (@healthaccess) August 27, 2018

Wow! This one is interesting not because it passed, but because it was unanimous (well, sort of...CA's assembly has 80 seats, so I guess the other 18 either didn't vote at all or abstained? I guess even Republicans are really feeling the heat on consumer drug prices. It'll be interesting to see what effect this bill has on unsubsidized premiums if it goes into effect, of course...

#SB1152(@SenatorDrEd22 @DrEdHernandez) is now on call on the California Assembly floor. Sponsored by @CPEHN and @SEIUCAL, it seeks to prevent hospital "patient dumping," providing guidelines for when homeless patients are discharged from a hospital.

— Health Access CA (@healthaccess) August 27, 2018

Ugh. This one is just depressing as hell. I mean of course I'm glad a bill has been introduced to deal with it, but it's just sad that such a bill is even needed.


In Washington State, they're dealing with the #ShortAssPlans problem from a completely different angle: Regulation by the state Insurance Commissioner. On the one hand, cracking down on them via legislation would be better since it'd be less subject to the whims of whoever happens to be running the insurance dept. at the time (that's how #ShortAssPlans became a threat in the first place--the ACA didn't restrict them; that was a regulatory decision by the Obama Administration, so it was easy for Trump to reverse it). On the other hand, legislation takes a lot longer to go through the process, so making this change via regulatory rule is probably the only way to ensure it goes into effect in time for January 2019:

Kreidler proposes restrictions for short-term limited duration medical plans, increased consumer protections
August 27, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler has proposed a rule to restrict the sale of short-term limited duration medical plans to three months, prohibit renewal and require enhanced disclosure to consumers about the limitations of coverage.

Currently, any insurer that wants to sell a short-term limited duration health plan in Washington state must first receive approval from the Office of the Insurance Commissioner (OIC). The federal rule expanding the duration of these plans to up to one year, with renewals for up to three years, also permits state insurance regulators to set standards for their own health insurance markets.

“Some consumers may be caught in a coverage gap and need a short-term medical plan,” Kreidler said. “But I want to be sure they understand the limitations of the coverage they’re buying, set minimum requirements for that coverage and do what I can to make sure that these plans do not destabilize our individual health insurance market.

Kreidler’s office determined that although some circumstances exist where these types of plans can fill a coverage gap for consumers, they should not be considered an alternative to comprehensive health insurance. In addition, improved disclosure is needed to make sure that people understand what is not covered by these plans.

Under the proposed rule:

  • Short-term limited duration (STLD) medical plans can last no more than three months and are not renewable.
  • A consumer can have STLD coverage for no more than three months in a 12-month period.
  • Insurers selling STLD medical plans must provide consumers with the disclosure form included in the proposed rule that clearly states the limitations of the coverage and prompts consumers to check to see if they are eligible to purchase coverage through Washington’s Health Benefit Exchange before they buy an STLD medical plan.

For the most part, I believe these first three bullets simply lock in Obama Administration regulations. However, Kreidler is also going a bit further with some other sensible requirements:

  • STLD medical coverage must offer major medical coverage, with a maximum total payment of at least $1 million. Any pre-existing condition look-back period cannot exceed 24 months. Consumer coinsurance cannot exceed 50 percent, and any insurer offering an STLD medical plan must offer at least one plan with a deductible of $2,000 or less.

In other words, they can no longer be total junk; they can only be...quasi-junk. Fair enough; this, combined with the 3-month limit, seems reasonable to me.

  • STLD application forms, policies and rates must be approved by OIC prior to being offered or sold.
  • STLD medical plan rescission and cancellation is limited to defined circumstances with requirements for adequate consumer notice.

Ah, yes...rescission. There's a horror from the past which we haven't had to worry about for the past 9 years...(sigh)

A public hearing on the proposed rule is scheduled for 1 p.m., Sept. 26 at the Office of the Insurance Commissioner, 5000 Capitol Blvd. SE, Tumwater, WA 98501.

OK, that's a whole mess of great (or at least promising, in the case of the CA bills...Gov. Brown will probably sign them all but you never can be sure...) news.

Now for the downside of the day:



Gov. Bruce Rauner vetoed a pair of bills over the weekend aimed at pushing back against efforts to dismantle the Affordable Care Act.

Rauner vetoed legislation Friday evening requiring the General Assembly to pass a supportive resolution before the state moves forward with any waiver reducing or restricting coverage under the Affordable Care Act or Medicaid.

He axed another Sunday limiting the duration of short-term health insurance plans to six months per year and requiring that the plans include notices alerting consumers that they’re not compliant with the ACA. President Trump’s administration issued rules earlier this month reinstating a 12-month enrollment limit on the plans, up from three months.

But wait, there's more!

Rauner also vetoed legislation increasing the legal age in Illinois to buy cigarettes and tobacco to 21.

Really? Cigarettes are still a thing these days? Apparently so.

On the other hand, there were a few bright spots on the healthcare front in Illinois as well:

Meanwhile, Rauner signed several healthcare bills over the weekend, and earlier in the week.

They include:

  • Strengthening safeguards for nurses and other employees at hospitals and retail healthcare facilities;
  • New restrictions on insurance companies that want to change prescription drug coverage midway through a contract; and
  • Requirements that healthcare workers receive a flu vaccine unless it’s against their religious beliefs or would cause them medical harm.

Um...OK, although there really shouldn't be religious exceptions for vaccines unless you also agree to never come into physical contact with anyone else, especially in a healthcare/medical enviroment. I guess this is better than nothing, though.