On February 21, 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to modify the definition of short-term, limited duration insurance to exclude it from individual health insurance coverage. Short-term, limited duration plans (STLDPs) are not required to meet Affordable Care Act (ACA) requirements, as they are currently only intended for use as temporary coverage in situations such as changing jobs. If the proposed rule is finalized, it would significantly harm those with pre-existing chronic conditions, like celiac disease, as it seeks to allow STLDPs to last up to 364 days, and be renewed, without having to meet important ACA-mandated patient protections.

Under this proposed rule, patients with pre-existing chronic conditions would be charged higher premiums, would not have needed medications covered, and could face limits on certain services and no limits on out-of-pocket costs. The expected outcome of this rule is for young, healthy people to abandon their marketplace insurance plans for the cheaper STLDPs, creating high risk pools and further destabilizing the markets – all of which have devastating effects on those with chronic conditions.

On behalf of the celiac disease and non-celiac gluten sensitive community, the Celiac Disease Foundation submitted a comment to the Centers for Medicare and Medicaid Services (CMS) strongly opposing this proposed rule. Please read the full comment below.

March 30, 2018

The Honorable Seema Verma
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, SW.,
Washington, D.C. 20201 Attention: CMS-9924-P,
P.O. Box 8010,
7500 Security Boulevard,
Baltimore, MD 21244-8010

RE: Proposed Rule, Short-Term, Limited-Duration Insurance

Dear Administrator Verma:

The Celiac Disease Foundation appreciates the opportunity to respond to the Proposed Rule entitled “Short-Term, Limited-Duration Insurances” promulgated by the Internal Revenue Service (IRS), the Department of Labor, Employee Benefits Security Administration (EBSA), and the Centers for Medicare & Medicaid Services’ (CMS) (the Proposed Rule).

The Celiac Disease Foundation is the nation’s leading disease advocacy organization for celiac disease and non-celiac gluten/wheat sensitivity. We accelerate diagnosis, treatments, and a cure through research, education, and advocacy to improve the quality of life for all those affected.

We write to oppose the policy contained in the Proposed Rule. We have strongly urged this Administration to prioritize its efforts on healthcare affordability and access so that people who truly need medical care to treat celiac disease and its associated conditions can continue to receive it. The Affordable Care Act, while not perfect, has offered a lifeline to individuals with chronic diseases and disabilities. The Proposed Rule offers no counterbalance to the recognized risks it imposes on marketplace stability, and no meaningful alternative for individuals relying on ACA plan coverage.

The Proposed Rule’s only mention of individuals with costly medical conditions was to acknowledge that short-term plan enrollees who develop a chronic condition would switch to marketplace coverage. This underscores our belief that individuals with chronic diseases will be disproportionately impacted by this proposed policy because:

  • Short-term health coverage is not a realistic option for people with serious medical conditions; and
  • The anticipated syphoning of younger, healthier individuals from the ACA risk pools will increase plan premiums and decrease the number of plans participating in the marketplace.

The Proposed Rule makes multiple mentions of the fact that short-term health insurance offers lower premiums for reduced benefits and patient protections that will likely attract younger, healthier individuals. It is unlikely that individuals with chronic diseases and disabilities would be able to meet medical underwriting standards to obtain this type of coverage and, if coverage is available, it would be associated with a high premium. These plans have additional shortcomings that make enrollment of little value to individuals with costly medical conditions, including:

  • Short-term insurance plans generally exclude coverage for preexisting medical conditions;
  • These plans do not have to cover essential health benefits, and most do not even offer coverage for prescription medications.
  • Issuers would be allowed to rescind or decline coverage;
  • Deductibles and cost-sharing obligations are often far more onerous than those contained in ACA plans;
  • Lifetime and annual caps can be applied to limit coverage

We are also concerned that insurance issuers and brokers will favor these plans over marketplace coverage because brokers can receive higher commissions and issuers can achieve profits that are not allowed under the ACA’s requirement that plan medical loss ratios be at least 80% of premium revenue.

The Proposed Rule acknowledges that lower-premium short-term plans are designed to draw younger and healthier individuals away from the individual marketplace and that they will likely do so. It further acknowledges that older, less healthy individuals will not have these “affordable” options and will remain in more comprehensive plans with escalating premiums, while simultaneously recognizing that a growing proportion of the nation’s enrollees have just one available plan.

We believe that intentionally taking action that will further reduce stability of the only health insurance available to many individuals with chronic diseases and disabilities is unconscionable and inconsistent with the Administration’s obligations to implement and maintain a stable marketplace. We urge you not to finalize the Proposed Rule because its disproportionate impact on individuals with chronic diseases and disabilities far outweighs any benefit younger, healthier individuals will obtain through low premiums.

Once again, the Celiac Disease Foundation appreciates the opportunity to submit comments on the Proposed Rule. Please do not hesitate to contact Marilyn G. Geller, Chief Executive Officer at [email protected] or 818.716.1513, x102 if you or your staff would like to discuss these issues in greater detail.

Warmest Regards,

Marilyn G. Geller
Chief Executive Officer

The Celiac Disease Foundation Submits Comment to the Centers for Medicare and Medicaid Services on Proposed Rule: Short-Term, Limited Duration Insurance