Trump admin seeks relaxed grandfathered ACA health plan rules that up out-of-pocket costs

Paying for Health Insurance Out of Pocket Maximum, OOP Health ...

Dive Brief:

  • The Trump administration proposed a rule Friday to allow some group health plans grandfathered under the Affordable Care Act to raise out-of-pocket costs for enrollees but still allow them to have health savings accounts. Such plans must not discriminate against enrollees with pre-existing conditions, but are exempt from many other ACA regulations. If they violate any rules regarding costs or structure they lose their grandfathered status and are required to follow all the mandates of the landmark 2010 law.
  • The proposed rule, issued by the U.S. Department of Labor, would relax some of the complex inflation and pricing calculations grandfathered plans must follow. The department admitted that the change could lead to higher deductibles and other out-of-pocket costs for the estimated 23.1 million enrollees in such grandfathered plans.
  • The rule stems from a 2017 executive order issued by President Donald Trump that allows regulatory changes to be made in response to perceived economic burdens imposed by the ACA. However, the Labor Department conceded in its Federal Register publication of the proposed rule that the current rules for grandfathered health plans probably weren’t that burdensome.

Dive Insight:

The administration has made no secret of its ire for the ACA and is actively trying to overturn it at the U.S. Supreme Court. A release explaining the changes notes fixed cost-sharing for high-deductible health plans would be raised, and “an alternative method of measuring permitted increases in fixed-amount cost sharing” has been introduced that “would allow plans and issuers to better account for changes in the costs of health coverage over time.”

The formal 76-page proposal, published in the Federal Register on Sunday, said premiums might go down as a result of the changes, but there were no estimates provided or circumstances where that might occur.

Moreover, the proposed rule also noted that the change could lead to more people foregoing healthcare because their out-of-pocket costs might become unaffordable.

The Labor Department also noted that there have been so few fluctuations in the state of grandfathered health plans in recent years that it was likely the current regulations were not overly burdensome in the first place.

Public comments will be solicited until mid-August before a final rule is issued.

Sen. Patty Murray, D-Wash., and ranking member of the Senate Health, Education, Labor, and Pensions Committee, wasted little time late last week blasting the proposal.

“Regardless of what the president wants to believe, we’re in the middle of a pandemic that is devastating families’ health and finances,” Murray said in a statement.





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