THE PROGNOSIS

About 30,000 Americans could be booted from association health plans next year, as Democratic-led states seek to block Trump administration regulations seeking to give people cheaper options. 

Democrats consider these plans to be “junk” insurance that costs less but could also deceive consumers by skimping on coverage. But the plans, which have proven unexpectedly popular and comprehensive, are about to be scuttled as they get caught in ongoing political battles over the future of Obamacare. 

A federal appeals court is currently weighing the Trump administration's ask to let the plans stand. But even if the court reverses the Democratic win in the lower court, the decision probably will come too late for consumers trying to decide on their source of coverage for 2020. 

Until the court issues a ruling, probably early next year, the chambers of commerce and trade associations who run these plans known as “AHPs” say they’ll be forced to suspend the coverage — a disappointment to enrollees who have found it less expensive than on the Obamacare marketplaces.

“We have multiple stories of people who couldn’t even afford individual insurance because it was $3,000 or $4,000 a month to cover their families,” said Teresa McKee, with the Nevada Association of Realtors. “[The AHP] has helped tremendously to alleviate those problems … it’s been really a boon to us.”

Nevada Realtors is one of dozens of groups that formed such plans after new rules from the Trump administration in 2018 made it easier for small businesses to band together to buy health coverage the same way large employers do. The association plans formed since then cover tens of thousands of people who are either self-employed or who work for small businesses, many of whom earn too much for federal subsidies to help them afford expensive marketplace coverage.

Yet these association plans have been caught up in the never-ending political wars over Obamacare. In March, a district judge sided with 11 states and the District of Columbia suing to block the Trump regulation — and yesterday, the administration tried to convince a three-judge panel on the U.S. Court of Appeals for the D.C. Circuit that the rule should stand.

There are two basic ways to view these association plans.

— Democrats — ever-attuned to actions by the administration that could be construed as dismantling Obamacare — argue the plans are simply a way to prevent people from getting benefits they're entitled to under the law. The administration has weirdly played into this argument, saying association plans are a way of getting around Obamacare regulations.

The rule “improperly allows small employers in associations to offer plans to their employees that violate the ACA’s consumer protections for the small group market, which the [Affordable Care Act] regulates more stringently than the large group market,” the attorneys general for California, New York, Massachusetts and other states wrote in a court brief filed over the summer.

—But those involved in administering association plans say they’re comparable to the workplace coverage 160 million Americans currently get, largely covering health benefits deemed “essential” under the Affordable Care Act and accepting all patients regardless of preexisting medical conditions.

In other words, the association plans allow people who work for themselves or small businesses to enjoy the types of more generous plans offered by large employers, advocates argue.

“A plan Walmart sponsors, a plan Amazon sponsors, a plan Boeing sponsors — [association plans] are subject to all the same rules that apply to large-employer plans,” said Chris Condeluci, a health policy consultant involved in a pro-AHP coalition.

The Small Business Association of Michigan and MichBusiness, another business group in the state, teamed up to start TranscendAHP for 2019. The plan has attracted participation from 440 small businesses in the state and covers between 4,000 and 5,000 people, according to Scott Lyon, a senior vice president for the Small Business Association of Michigan.

Lyon said he was skeptical of association plans when the administration announced the new rules but has been surprised at how popular TranscendAHP has become. The plan will have to shutter for 2020 because of the lawsuit, but Lyon believes it otherwise would have kept growing rapidly.

“It was very popular,” Lyon told me. “I think if we were still allowed to market this, we’d probably have upwards of 10,000 employees enrolled now, it was doing that well.”

Both Lyon and McKee said their association plans cover the essential health benefits required of individual marketplace plans, which include categories such as prenatal care, mental health care and prescription drugs.

Association plans aren’t technically required to cover these benefits. But neither are large employer plans — and the vast majority of these plans voluntarily cover the full range of benefits. That’s why Congress didn’t see a need for many more regulations of large group plans under the ACA, whereas they did seek stricter requirements for individual and small group plans, whose coverage tended to be less generous at the time.

Advocates of association plans take issue with characterizations of the plans as “junk” insurance. Katie Mahoney, vice president of health policy at the U.S. Chamber of Commerce, said she doesn’t know why a state or local chamber of commerce “would risk their reputation on offering junk insurance.”

“Our chambers take their brand and their reputation very, very seriously and would be loath to offer a plan that would in any way mislead their members,” she told me.

There’s also anecdotal evidence that association plans are providing lower premiums than can be found in the individual marketplaces. Mahoney said 109 chambers of commerce are participating in association plans covering more than 21,000 people. Some customers have reported saving as much as 60 percent on monthly premiums by switching from marketplace coverage to an association plan, she said.

Lyon said most TranscendAHP enrollees have reported saving 25 percent to 35 percent compared with what they were previously paying for individual or small group coverage. “The opportunity for us to purchase health insurance on behalf of our members … to have that taken off the table is super frustrating,” he said.

AHH, OOF and OUCH

AHH: A group of experts on an advisory panel to the Food and Drug Administration have unanimously backed the expanded used of a fish oil-derived drug meant to protect against heart problems.

The drug is used to treat those who are at a high risk for heart attacks and strokes, even when they take cholesterol-lowering drugs, our Washington Post colleague Lenny Bernstein reports.

The agency, which usually follows the advice of the expert panel, could make a decision on the drug, called Vascepa, next month.

“The drug, a purified version of the Omega-3 fatty acid found in fish, is aimed at some of the more than 40 million people in the United States who take statins to control their LDL — or ‘bad’ — cholesterol and have adopted lifestyle changes, yet remain at serious risk of cardiovascular problems because of elevated triglyceride levels,” Lenny writes. “Triglycerides are another type of fat in the blood. When their levels are too high, generally more than 200 milligrams per deciliter of blood, the result can be deaths, heart attacks, strokes, unstable angina or the need for cardiac surgery.”

Although the panel voted 16 to 0 to back the drug, its members “struggled with exactly who should take the drug … In the end, they offered a wide variety of suggestions on age and triglyceride limits, among other things, that the agency will have to sort out before instructing doctors and patients on use of the drug.”

OOF: The number of reported cases of vaping illness nationwide is still increasing, according to new data from the Centers for Disease Control and Prevention, but at a slower rate than in previous weeks.

There are now 2,172 confirmed and probable cases of the vaping-related lung illness, up 121 cases from the agency’s last update last week. The cases have been reported in every state but Alaska, as well as the District of Columbia, Puerto Rico and the U.S. Virgin Islands.

So far, there have been 42 deaths in 24 states and the District.

OUCH: Cigarette smoking among adults in the United States reached an all-time low in 2018, according to new data from the CDC. Last year, 13.7 percent of U.S. adults, or 34.2 million people, smoked cigarettes. That’s slightly down from the 14 percent of U.S. adults who smoked cigarettes in 2017.

“This marked decline in cigarette smoking is the achievement of a consistent and coordinated effort by the public health community and our many partners,” CDC Director Robert Redfield said in a statement. “Yet, our work is far from over. The health benefits of quitting smoking are significant, and we are committed to educating Americans about the steps they can take to become tobacco-free.”

Cigarettes are still the most-used tobacco product in the country. Overall, 19.7 percent of adults reported using a tobacco product, including cigars, e-cigarettes, smokeless tobacco. E-cigarette use saw an increase among adults from 2.8 percent to 3.2 percent, which is a “reversal from the decline observed among adults during 2014-2017,” per the CDC.

REPRODUCTIVE WARS

— Two Republican Ohio state lawmakers have sponsored a bill that would completely ban abortion in the state. The bill would in part legally recognize unborn fetuses as people, and would “subject to already existing murder statutes” anyone who performs the procedure, our Post colleagues Michael Brice-Saddler and Hannah Knowles report.

State Reps. Ron Hood and Candice Keller are the lead sponsors of the measure, according to a news release from the Right to Life Action Coalition of Ohio, but it was not immediately clear if the bill had yet been introduced in the Ohio legislature. Another Republican, Ohio state Rep. John Becker, told a Cleveland.com reporter that he co-sponsored the bill.

“In an interview with The Washington Post late Thursday, Kellie Copeland, executive director of NARAL Pro-Choice Ohio, said Keller and Hood had introduced a similar, flat-out abortion ban in the previous General Assembly,” Michael and Hannah write. “While she has not seen this bill’s language, she expects it to be very similar to the last session’s legislation, which Copeland said did not pass in either chamber.”

The latest proposal out of Ohio “follows a wave of red-state restrictions on abortion as conservative lawmakers seek a reexamination of Roe v. Wade, contributing to a growing gap in states’ stances. This year’s new laws have been repeatedly blocked by the courts.”

HEALTH ON THE HILL

— Republicans blocked an effort yesterday to push through a gun bill, just as news of a shooting at a high school in California unfolded.

Sen. Chris Murphy (D-Conn.) tried to pass a House-passed universal background check bill through the Senate by unanimous consent, which would have allowed the bill to skip debate, but it was blocked by Sen. Cindy Hyde-Smith (R-Miss.) who argued the bill “should not be fast-tracked by the Senate,” BuzzFeed News’s Paul McLeod and Kadia Goba report.

“The American public are not going to accept silence from the body week after week, month after month in the face of this epidemic carnage that is happening in this country,” Murphy said.

Murphy later said, after learning about the shooting at a Los Angeles-area high school that left at least 2 dead and 4 injured, that he doesn’t believe it will make a difference.

“I wish this weren’t the case, but Republicans’ interest in working on guns is driven by casualties of 15 or more. It’s so awful that it works like this,” he said. “I don’t doubt that we’ll be back in a conversation about background checks, but it probably won’t happen until there’s another epic-scale shooting.”

INDUSTRY RX

— Apple has launched a research app that will allow Apple device users to enroll in three observational studies and share health-related data on mobility, women’s health and hearing, Stat’s Rebecca Robbins reports.

The company is working with the National Institutes of Health and the American Heart Association and institutions including Harvard T.H. Chan School of Public Health on the studies.

“Amid rising concern about health data privacy, the tech giant has vowed not to sell the data collected from the studies. Apple will allow participants to control which types of information they share and to delete data within 24 hours of their collection,” Rebecca reports. “The company may, however, use the collected study data to refine its algorithms; for example, it could mine for correlations between heart rate data and activity data — how many steps you take, how often you stand, or how often you exercise — to try to improve the notifications it sends Apple Watch users who have an irregular heart rhythm or a high heart rate.”

— And here are a few more good reads: 

AGENCY ALERT

The FDA said Dollar Tree purchased drugs from foreign companies that failed to follow manufacturing standards and displayed a pattern of serious violations.
Stat News

STATE SCAN

The website looked like the Obamacare marketplace, the phone salesman was friendly and helpful. But the plan she bought covered almost nothing. What gives?
Philadelphia Inquirer
The Democratic Party’s internal dispute over Medicare for All has reached this battleground state, and so far, supporters of a single-payer health care system are finding a tough audience.
Wall Street Journal
In a letter sent to students just after 10 p.m. Tuesday, top USC officials warned against the dangers of opioid use.
Los Angeles Times

MEDICAL MISSIVES

A federal audit of 19 California nursing homes released today found hundreds of violations of safety and emergency standards, putting vulnerable nursing home residents at increased risk of injury o…
Kaiser Health News
About 80 million people with diabetes around the world need the hormone, and half of them can’t afford it. Creating competition could help, the agency said.
New York Times
The pneumonic plague is considered to be the most severe and viral form of the disease.
Michael Brice Saddler

DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee will hold a hearing on the nomination of Stephen M. Hahn to lead the Food and Drug Administration on Nov. 20.
  • Senate Finance Committee Chairman Chuck Grassley (R-Iowa) will participate in a Committee for a Responsible Federal Budget event on health care on Nov. 21.

SUGAR RUSH