Short-Term Health and Agents Star at House ACA Hearing

Dean Cameron made a strong case for carefully designed short-term health insurance policies, and the value of health insurance agents and brokers, earlier this week at a House hearing on updating the Affordable Care Act. Cameron — who is the director of the Idaho Department of Insurance and the president-elect of the National Association of Insurance Commissioners — said the locally run ACA public health insurance exchange in Idaho gets about 80% of its business through agents. The agents "have to go through an extra training program to work through our state-based exchange, so that we make sure they are covering all of the facets appropriately," Cameron said at the hearing, which was held online and organized by the House Energy and Commerce health subcommittee. "Frankly, that's the safest way. The agents are responsible for what they helped individuals purchase." Cameron also defended short-term health insurance policies against some Democrats' assertions that all of them are junk insurance. The policies "are not 'junk insurance' just because someone dubbed them as such," he said. Idaho has special short-term policies, or "enhanced short-term plans," that offer richer benefits than some of the individual and family major medical insurance policies issued by the same carriers, Cameron said. Cameron testified at a subcommittee hearing on efforts to expand access to health care and health coverage by improving the current ACA-based framework, as proposed by President Joe Biden. Rep. Bobby Rush, D-Ill., said efforts to improve the ACA, through the new American Rescue Plan Act and other means, are long overdue. "In 2020, it was estimated that 846,000 Illinoisians lost employer-sponsored insurance," Rush said. "Knowing we're in a pandemic, it's critical that we ensure that everyone has access to high-quality, affordable health care. COVID-19 is casting a bright light on the disparities which are too common for Black and brown Americans in my district and around this nation. "It is our duty to ensure that we conduct outreach to African Americans, to Latinos, to Asians, to those who are more likely negative health outcomes from COVID-19," he said.

ACA Update Bills

Lawmakers at the hearing discussed a number of ACA-related bills at the hearing. One, H.R. 1796, the "Health Care Enrollment Innovation Act" bill, would provide $200 million that states and state exchanges could use to promote greater enrollment in individual and small-group health coverage. The act appears to provide funding for technology and marketing programs but does not mention agents and brokers. Another, H.R. 1872, the "Marketing and Outreach Restoration to Empower Health Education Act of 2021" bill, would provide $100 million in funding to improve efforts to promote HealthCare.gov, to federal ACA public exchange system that serves states that have been unable or unwilling to set up locally run ACA exchange programs. H.R. 1872 is geared toward supporting ACA exchange Navigators, or ombudsmen, and it calls for the secretary of the U.S. Department of Health and Human Services to develop metrics for assessing work of Navigators, in response to allegations that Navigators have low ACA plan signup rates. The Navigators' defenders have argued that the Navigators have many responsibilities other than helping consumers sign up for exchange plans and should be assessed using other measures.

Cost and Quality Ideas

Rep. Anna Eshoo, D-Calif., the health subcommittee chair, said one quick way to improve access to health coverage and health care would be for the 14 states that have not yet used ACA subsidies to expand Medicaid to do so. Several speakers talked about the need to expand use of "invisible reinsurance" programs, or programs that use cash from a variety of subsidies to buffer health insurers against some of the costs involved with covering people who are likely to have high medical bills. Mari Jameson Carey, executive director of the Association of Independent Doctors, argued that requiring full disclosure of health care prices would be a good way to bring costs down.

Short-Term Health Insurance

Much of the discussion focused around short-term health insurance policies, which have been exempted from the rules that apply to ACA-compliant major medical insurance policies. Rep. Betty Castor, D-Fla., has introduced a bill, H.R. 1875, that would eliminate the exemption. Eshoo and other lawmakers, including Rep. Annie Kuster, D-N.H., talked about reports that many holders of short-term health insurance policies end up facing surprise medical bills because of unexpected coverage limits. Cameron argued that states can make short-term health insurance policies a good alternative for people who are unable to afford major medical insurance, by, for example, requiring the policies to cover the same services major medical insurance policies cover. Today, Cameron argued, individual major medical insurance is simply too expensive for young adults who earn too much to qualify for rich ACA premium tax credit subsidies.

Agents

Several Republicans at the hearing, including Rep. Billy Long, R-Mo., and Rep. Buddy Carter, R-Ga., argued that supporting agents and brokers would be a better value than increasing subsidies for Navigators. Long, for example, cited reports that Navigators account for only about 1% of ACA public exchange program signups. Participating from a car, Carter noted that Georgia wants to try to provide exchange services to its residents through private web brokers, rather than through HealthCare.gov or a state-run public exchange program.

Remote Life

Some lawmakers and witnesses conferenced into the hearing from offices, or home offices, but some conferenced in from living rooms. Long had to leave the hearing early to help his wife with her car. Carter conferenced into the hearing from a car. (Photo: Shutterstock)