Transparency lagging

The Affordable Care Act (ACA), passed in 2010, expressly requires transparency for health plans, including those sold inside, and outside of, the exchanges through which tax subsidies are available to individuals and businesses.  Given the phenomenal commitment of taxpayer resources to health insurers this seemed a reasonable tradeoff.  However, under the leadership of Marilyn Tavenner, the future head of America’s Health Insurance Plans, the Obama administration slow-walked implementation of this requirement.

Finally, on August 11, over five years later, there was action, if it could be interpreted as such.  Three federal agencies promulgated some loose guidance.  Those plans eligible for tax subsidies through exchanges run, or facilitated, by the federal government through Healthcare.gov would have very minimal reporting requirements.  For such plans it is hard to describe any of the information to be shared as different from that already available to a Healthcare.gov enrollee.  Meanwhile, the state-run exchanges were not addressed.  And on the U.S. Department of Labor website, it was stated, vaguely, that the federal government would, for non-exchange health plans, “propose transparency reporting . . . in the future.”

{mosads}In simpering deference to insurers, the federal government made it clear that for non-exchange plans it would “implement any transparency reporting requirements . . . only after reasonable notice and comment, and after giving those issuers and plans sufficient time, following the publication of final rules, to come into compliance with those requirements.”

In other words, given the power insurers have exerted to date over all ACA rulemaking, it seems that transparency regulations for non-exchange plans may never be implemented.  Even if adopted, those standards might materially differ, according to the Obama administration, from those announced August 11, making it harder for consumers to make informed comparisons.  And yet, in December 15, 2009 floor debate, then-Senate Finance Committee Chair Max Baucus (D-Mont.) had crowed, “There is public access to comparable information, more transparency, and I could go on and on and on.  There are many provisions which take effect right away and not at a later date.”  Well, that was then and this is now.

In California, which has a state-run exchange, a Kaiser Family Foundation (KFF) poll found 87 percent of those renewing their health plan coverage through the exchange didn’t comparatively shop.  Because studies have shown it is such enrollees who tend to disproportionately shoulder rate increases, would it not be helpful if their government were to require more information in exchange for their compelled participation?  As state-run exchanges, particularly, saw a huge drop-off in 2015 enrollment – with California retaining only two-thirds of 2014 enrollees, while increasing enrollment overall only by 1 percent  – more consumer information could only be useful.

Literacy with respect to health insurance terms is a longstanding problem, given how enormously complicated health insurance is.  Only 53 percent of those uninsured in a KFF poll reported in November 2014 could define an annual deductible, for example.  That’s a pretty significant problem given that the 2015 deductible to be paid before one can even access care might be as high as $13,200 for a family – a deductible toward which no tax subsidies whatsoever are applicable.

The tepid Obama administration action to date in implementing, through regulation, the consumer protections of the ACA, has suggested it is content to pour, unconditionally, tax dollars and taxpayers alike into the gaping maws of health insurers.  This is a result that could only bring smiles to the faces of Tavenner and all the other legions of administration alumni employed by the healthcare industry.

Williams is an Olympia, Washington attorney and frequent columnist on healthcare issues.