By Rachel Schwab and Dania Palanker
This Mother’s Day, both Congress and the Trump administration have put together a special gift basket of policies that continue to threaten access to health care for women, mothers, and families everywhere. The persistent efforts to reduce federal standards and roll back key consumer protections come wrapped in the all-too-translucent cellophane of undermining the Affordable Care Act (ACA) after failed attempts to repeal the law. But don’t be fooled – this basket is filled with re-gifted policies.
Wine, Cheese, and Gender Discrimination in Short-Term Plans
Mothers everywhere should hesitate before unwrapping the Trump administration’s recent regulatory gift, which could open the door to increased gender discrimination. Under the guise of expanding choice, the administration has proposed rules that would allow short-term health plans to become long-term coverage options. These products routinely exclude coverage of critical women’s health services, such as maternity care, birth control, and pre-existing conditions. This leaves mothers and their families in the lurch if they become pregnant or find out they have cancer or another illness the insurer decides is preexisting. Plus, women have to pay for cost-sharing for preventive care—if it’s covered – including birth control and cancer screenings. Some short-term insurers even charge women more than men. States can ban or limit short-term plans, but if your state doesn’t, consider suggest bypassing this gift and going straight for the rosé.*
*But be aware that some short-term plans exclude coverage for services for health needs arising when a covered person is intoxicated.
Farm Fresh Fruit and a Farm Bill to Lower Coverage Quality
Tucked among the peck of pears in their gift basket, mothers are sure to find a couple of ploys to expand another type of non-ACA-compliant coverage: association health plans. In addition to the Trump administration’s proposed rule to reduce federal guardrails on these products, Congress is considering a bill that would provide $65 million to help associations of farmers and other agriculture workers set up association health plans. These plans have a long history of fraud and insolvency, often leaving individuals and small employers holding the bag for unpaid medical claims. And like short-term plans, association health plans can discriminate against consumers based on their gender and exclude certain benefits like maternity. But, in the words of an association health plan advocate, “everyone focuses on the negative.” So maybe enjoy a nice juicy pear instead.
Strong Tea, Weak Benefit Requirements
The next gift is far from our cup of tea. The ACA expanded access to comprehensive insurance coverage for mothers and their families through the essential health benefits (EHB). These require health plans to cover maternity and newborn care, as well as coverage for services like prescription drugs and mental health treatment. The new benefit and payment rule recently finalized by HHS could greatly weaken these requirements by giving states increased flexibility to select an EHB “benchmark” plan and substitute benefits in that plan both between and within categories. If states elect to use this new flexibility to weaken the EHB, insurers can create plans that diminish coverage in certain EHB categories to “cherry pick” healthier or less risky populations. Mothers who rely on the ACA’s comprehensive coverage requirements may find that these weakened EHB standards leave them without access to the services that they need. This can be particularly harmful to mothers of sick kids if insurers cut services used by medically fragile children. It’s now up to the states to decide if they will continue brewing a cup that’s steeped in comprehensive benefit requirements.
Fresh Cut Flowers and Cuts to Federal Funding
You don’t need to spend a fortune on mom, but recent federal funding cuts are a less-than-perfect Mother’s Day present. Last summer, the Trump administration slashed advertising funds leading up to open enrollment. A recent analysis of enrollment across the country found that this likely led to decreased signups on the federally facilitated marketplace, including an almost 40 percent drop in new enrollees since 2016. But the administration went even further by cutting off funding for federal cost-sharing subsidies, which caused insurers to raise rates on popular silver-level plans. While many states stepped up to ensure that consumers did not face the fallout of the federal government’s cuts, mothers who don’t qualify for federal premium assistance have found it difficult to purchase an affordable plan. In the future, a nice card or a phone call is a better budget-friendly way to say Happy Mother’s Day.
Wrap It All up in a Bow of Uncertainty to Encourage Insurers to Flee
Not a great selection so far. But beyond the array of federal actions to undermine the ACA’s protections for mothers and their families, the general uncertainty surrounding the law is the gift that, unfortunately, keeps on giving. Congress’ multiple attempts to repeal the law, the President’s misleading statements about whether the ACA remains in effect, and the upcoming elimination of the individual mandate penalty are all contributing to an uncertain policy environment. Insurers have repeatedly expressed that federal uncertainty causes market exits and rising premiums. Because insurer participation is crucial to ensuring that consumers have access to comprehensive coverage, mothers are likely to face narrowing and increasingly unaffordable plan offerings if nothing is done to prevent these exits. And ribbon curls can hardly mask that reality.
Suffice it to say, this gift basket is a bit of a dud. But it’s not too late to give mothers the present they deserve: access to affordable and comprehensive coverage.