Texas physicians could see a flood of new insurance plans — including some to cover themselves and their employees — under President Donald Trump's executive order that directs federal agencies to design lower-cost plans outside the Affordable Care Act.
The order, signed Thursday, would allow for so-called association health plans in which individuals or small businesses can band together to buy health insurance. TMA staff have begun an in-depth review of the order as well as another presidential directive issued on Friday that would eliminate federal subsidies to insurance companies that offer plans through the ACA exchange.
TMA currently offers a health plan to its members through the Texas Medical Association Insurance Trust (TMAIT); however, it was closed to new entrants in 2013 because of limiting language in ACA. Trump's order could reverse that.
"This could be a big deal," said James Prescott, administrator of TMAIT. "We have the infrastructure in place, the staff in place. If this goes forward, for us it would be a return to a segment of the insurance business we offered to TMA members for over 40 years. We anticipate that eligible TMA members would have access to an individual PPO plan, which they don't have now."
President Trump's executive order gives three cabinet departments 60 days to rewrite federal rules for association health plans. ACA requires that such plans be from the same state and meet certain protections, such as coverage of essential health benefits. The administration is likely to exempt associations from those rules.
Any regulations are expected to be debated and challenged, and several state insurance commissioners have said they'd go to court to stop the order.
"All any of us can do now is wait," Mr. Prescott said.
If and when new plans appear, Mr. Prescott says, physicians should pay close attention to how they are regulated. "Years ago, similar insurance arrangements had no clear regulatory oversight, and numerous bankruptcies occurred, leaving individuals responsible for payments to physicians, hospitals, and other medical providers."
Physicians also should consider whether any plan abides by a state's consumer protection laws. If not, consumers would have little recourse if a plan can't pay a claim, nor would there be any appeals process for denied services, Mr. Prescott says.
He also says it is crucial to see how a plan keeps costs low. "Generally, premiums can only be reduced by some type of restrictions, such has higher copays, higher deductibles, smaller physician networks, or the removal of previously covered items."
TMAIT was created and is exclusively endorsed by TMA to provide insurance products to TMA members, their dependents, and staff. TMAIT offers group insurance contracts underwritten by Prudential and Blue Cross and Blue Shield. TMAIT's wholly owned insurance agency represents many different insurance carriers offering a variety of individual insurance products to TMA members. More information about TMAIT can be found on its website.
Action, Oct. 17, 2017