ACP: Executive Order May Result in Significant Harm to Patients by Allowing Plans to Circumvent Health Insurance Market Rules

Statement attributable to:
Susan Thompson Hingle, MD, MACP
Chair, Board of Regents, American College of Physicians

Washington, DC (October 12, 2017)—The American College of Physicians (ACP) is extremely concerned  about a new executive order that  President Trump has signed that puts in motion changes through the regulatory process that would lift many of the Affordable Care Act’s (ACA’s) insurance rules. Once again this year, millions of Americans are at risk of losing health insurance coverage and all Americans are at risk of losing critical patient protections.

ACP has said repeatedly that any attempts by Congress to “repeal and replace” the ACA must first, do no harm to patients. This executive order utterly fails that test.

Under the executive order small employers would be allowed to purchase health plans that do not meet the ACA’s requirement to provide essential health benefits. This means that these plans would no longer have to cover medical care patients need; plans could choose not to cover pregnancy, maternity, and newborn care, or even chemotherapy. This would also mean that the ACA’s prohibition on annual and lifetime limits on coverage would no longer apply to any service an employer decides is not essential. These changes would be devastating for patients who need access to the “non-essential” services, leaving them with potentially millions of dollars in out-of-pocket costs despite being insured.

Further, the executive order would permit individuals to keep bare-bones insurance plans longer-term. Under the ACA, these types of plans were intended to be temporary while they purchased a plan that complied with the law’s protections. People who keep these plans for the year that the executive order now allows are at risk of not having the care they need should they get sick during that time.

Under the executive order, the individual insurance market would be critically destabilized. Healthier people are more likely to choose bare-bones plans that do not include essential benefits and other patient protections, driving up premiums in the individual market because the people left in the individual market will typically be sicker. Small employers choosing association health plans may also destabilize the market if their employees (many of whom now get coverage in the individual insurance market) are healthier, leaving less healthy individuals in the individual market. Insurers will be forced to either leave the markets in droves or charge much higher premiums.

This executive order violates the clear intent, and likely the statutory requirements, of the ACA; that every American has access to a health plan that will allow them to get critical medical services they need. Every American should have a plan that covers needed care, does not impose annual or lifetime limits, or exclude or charge more to those with preexisting conditions. The executive order must not stand. ACP will consider all avenues to prevent these changes from taking place.

About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

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