ACR Says Short-Term Insurance Plans Could Hurt Patients With Rheumatic Diseases

The Center for Biosimilars Staff

The American College of Rheumatology (ACR) told CMS in a letter this week that short-term, limited-duration insurance plans could reduce or restrict access to crucial care for people living with rheumatic diseases.

The American College of Rheumatology (ACR) told CMS in a letter this week that short-term, limited-duration insurance (STLDI) plans could reduce or restrict access to crucial care for people living with rheumatic diseases.

In February, the Trump administration proposed a rule that would extend the time that Americans can remain in STLDI plans from 3 months to 12 months. The administration says that the change will provide affordable coverage options to individuals and families who cannot afford plans that meet Affordable Care Act requirements, including some essential health benefits and protections for people who have preexisting health conditions.

“We recognize that extending coverage from [3] months up to [12] months may provide some individuals with more gap coverage than previously available, but we do not believe this coverage would provide benefits that most rheumatology patients need,” wrote David I. Daikh, MD, PhD, president of ACR, in the letter.

Furthermore, the letter argued that 12-month STLDI plans could create confusion for patients, as these plans may be mistaken for 12-month major coverage plans. Should CMS forge ahead with STLDI plans, ACR called for a requirement to disclose to consumers that essential health benefits that may not be included in a STLDI plan. It also asked that consumer-oriented price information—including such statements as “If you develop a disease or condition during this coverage period, you may not be eligible for benefits such as specialty drugs for rheumatoid arthritis that afflicts 1% of Americans and which can cost $58,000 per year”—be included in each STLDI plan’s information, and that consumer-friendly tables clearly identify differences between plans by noting the qualities of individual plans that are not features of STLDI plans.

ACR also asked CMS to carefully consider the question of how younger, healthier enrollees leaving the exchanges to purchase STLDI plans would affect the insurance market’s stability, and whether the exit of such enrollees could lead to higher premiums for patients with rheumatic diseases, compounding problems with affordability and access that this patient population already faces.