Senators are compiling a list of recommendations for a health insurance proposal tied to President Trump's executive order on Obamacare.
The proposal, released this month, would loosen the rules that allow individuals and small businesses to band together for the purpose of buying health insurance.
Among the possible recommendations are specifying that someone who is older could not be charged more for medical coverage, requiring insurers to set aside a specific amount of funding so they do not become insolvent, and regular oversight and reporting requirements. The recommendations were discussed in a Senate Health, Education, Labor and Pensions Committee roundtable Tuesday, based on testimony from a group of healthcare experts and providers.
Proponents of association health plans say they could offer an alternative to people who cannot afford the premiums under Obamacare. They cite examples such as Uber drivers, dog walkers or small restaurants banding together so that they can have greater negotiating power against health insurance companies. Regulations currently stipulate that members have to be in the same industry and that they have to be involved in the day-to-day decisions of a business, which would change under the Trump administration's proposal.
But critics of the rule say the population would be segmented even more so that sicker customers are left in the Obamacare exchanges, driving up costs there.
"As with most regulatory actions, there are advantages and disadvantages, there will be intended and unintended consequences, and there will be those who are financially better off and those who are not," said Mike Sturn, principal and consulting actuary at actuarial firm Milliman, who spoke at the roundtable.
Sen. Bernie Sanders, I-Vt., said the administration's proposal was headed in the "wrong direction," warning that the plans would not be required to offer the range of medical services provided by Obamacare, from maternity care to mental health treatment, and would not protect people with pre-existing illnesses such as cancer or diabetes.
Two of the witnesses – Jennifer Kimmich, a co-owner of a brewery that offers its more than 50 employees medical plans, as well as Tess Stack Kuenning, president and CEO of Bi-State Primary Care Association in Vermont, a community health center – said that the government's focus should be on fixing Obamacare. They cited the need for wider networks of doctors and hospitals. Kuenning warned that someone without adequate health insurance would not be able to receive all the services they need and that lack of reimbursement for certain services would strain providers.
But there was widespread disagreement during the discussion about what impact the rules would have.
"A particular plan cannot vary based on the health condition," said Chris Condeluci, a health policy attorney at CC Law & Policy who helped write Obamacare.
While he acknowledged that a range of medical benefits may not be required for all association health plans, he added, "many of the other Affordable Care Act requirements and consumer protections will apply,” referring to the formal name for Obamacare. He cited the example of capping out-of-pocket spending, and disputed that people with pre-existing illnesses would be denied coverage.
Sen. Mike Enzi, R-Wyo., who led the hearing, declined to say which recommendations he agreed with.
"I'll be passing those on," he said. "I don't have to rule on them. This is up to the administration to put them in place. I collect information."
He noted that he supported association plans overall and pointed to one of the other witnesses in the roundtable, Brad Johnson, who spoke about the Wyoming Chamber Health Benefits Plan, which has kept premiums at the same rate for four years and represents a range of workers, including truck drivers and lawyers. Enzi said he would "make sure that what the administration is planning "isn't going to interfere with what he is already successfully doing."
He added that he also supported the creation of invisible high-risk pools, which didn't come up during the roundtable. The provision, which has been tried in some states, allows the government to reimburse insurers for taking care of sicker patients so that premiums don't rise for all beneficiaries.