Changes are finally coming to states’ health insurance marketplaces. For small businesses, these changes can’t come soon enough. New rules prohibiting discrimination and strengthening oversight of rate increases will protect small businesses from rate shocks. A guaranteed essential benefits package will provide assurance of a minimum level of coverage. And new state insurance exchanges will enhance choice and competition.
But there’s one segment of many states’ insurance markets that is looking to dodge these new rules: association health plans (AHPs). AHPs are coordinated by membership associations – for example, state and regional chambers of commerce. Indeed, some state chambers are among the groups pushing to shield AHPs from having to play by the same rules as other health plans as the Affordable Care Act’s market reforms phase in.
But who really wins if association health plans are allowed to skirt market reforms and thumb their noses at the new rules?
Unregulated AHPs threaten the success of the new state insurance exchanges: by cherry-picking out the youngest and healthiest enrollees, they could stick an exchange with an older and more illness-prone population. That’s clearly not good for any small business participating in the exchange.
On the flip side, businesses getting their health coverage through AHPs won’t have the benefit of the ACA’s new protections – they’ll still be subject to rate discrimination, unreviewed rate hikes, and “thinsurance” (policies with such skimpy coverage they’re barely worth the paper they’re written on). It’s hard to describe that as “winning,” either.
The real winners from allowing AHPs to continue unregulated? The insurance companies (who get to keep doing business as usual, as if health care reform never happened) and the associations that make a regular income from marketing AHPs to their members.
The solution? That’s easy enough: make AHPs play by the same rules as any other health plan in the small group or individual market. Some groups that sell association plans to their members will undoubtedly lobby tooth and nail against this idea, but if they do they’re putting their own bottom line ahead of the best interests of the broader community – not to mention their own members.