Trump administration zeroes in on increasing competition in healthcare

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WASHINGTON — While the Trump administration has taken steps to reduce healthcare costs for Americans, more still needs to be done. That’s the conclusion of Brian Blase, special assistant to the president for economic policy, who said the current healthcare system works well for powerful interest groups and large institutions, but not well for families and patients.

“Much more work needs to be done to address broader health system problems,” he said speaking at a National Association of Health Underwriters conference Tuesday. “An increasing number of consumers and patients are frustrated, and [are] not served well by enormous complexity, confusing bills, rising costs and uneven customer service.”

But the Trump administration has made improvements to the system, he said. Blase praised efforts to expand association health plans, which allow smaller employers to band together with others based on industry and purchase large group health plans. He said they will increase competition across the market and help smaller employers, who have historically struggled to offer competitive health plans to employees due to cost.

“Expanded AHPs will lead to lower premiums across the entire small group market because of greater competition,” he said. “Many employers will offer coverage for the first time as a result, reducing the number of people uninsured.”

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The Trump administration in August issued a rule that allows for the sale and renewal of short-term, limited duration plans that cover an initial period of less than 12 months and a maximum of 36 months — upending an Obama administration rule that restricted these plans to less than three months in duration. These short term plans typically cost less than Affordable Care Act plans, and offer a “potentially attractive” option for the uninsured, those with gaps in employment and individuals struggling to afford premiums, Blase said.

“By freeing people to renew their plans up to three years, the administration’s actions reduce application costs, lower the risk of loss of coverage and allow for more innovation in plan design,” he said.

But there have been some concerns about the coverage provided under short-term plans. “Short-term insurers can charge higher premiums based on health status, exclude coverage for preexisting conditions, impose annual or lifetime limits, opt not to cover entire categories of benefits (such as substance use disorder treatment or prescription drugs), rescind coverage and require higher out-of-pocket cost-sharing than under the ACA,” Katie Keith, principal at Keith Policy Solutions wrote in a blog for Health Affairs in August.

In the individual market, the administration has also approved seven 1332 waivers, or state innovation waivers, for risk mitigation programs like reinsurance. This allows states to up enrollment and decrease premiums, Blase added.

Blase said the White House will continue to work to increase competition among healthcare providers, ultimately expanding quality and producing positive results for consumers. Options like Medicare for All just won’t work, he said.

“We believe that consumers working with their providers are in the best position to determine value,” he said.

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