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 Trump's plan rests on one main pillar, the creation of associations
in which multiple employers can band together to buy health plans
under the same law that large employers do. That law rests outside
of many of the mandates of the 2010 Affordable Care Act, dubbed
Obamacare.
Here are some questions and answers about these plans.
WHO CAN BUY THESE PLANS?
Potentially, small business employees and maybe even more people
would be able to buy such plans. The executive order envisions that
associations will form to offer these new health plans for small
businesses that want to join together. It is not clear from the
order whether freelance workers or other individuals interested in
buying health insurance outside of Obamacare would be able to access
these association plans through other routes. That may be decided in
the federal rule-making process, which takes months.
WHO WILL FORM THESE NEW ASSOCIATIONS?
There currently are some associations that have united to buy health
insurance, but the order imagines the creation of many new
associations around the country. By allowing small businesses to
join forces to create a larger pool of employees when buying
insurance, these associations can decrease the risk of having a
higher proportion of members with costly illnesses that can drive up
coverage costs for small employers.
It is not clear who would create these groups, but there are some
employer trade groups, like the National Restaurant Association,
that have advocated this year to allow restaurants to band together
to buy healthcare.
WHAT'S THE NEXT STEP?
Groups first need to create an association, register it with the
U.S. Labor Department, design the benefit plans, sign up medical
providers or hire a third-party company that establishes networks of
doctors, and then advertise and sell those plans to employees,
insurance experts said.
Signing up providers such as doctors and hospitals could be
challenging, especially across state lines, said Dave Dillon, a
fellow and actuary at the Society of Actuaries. Doctors and
hospitals charge higher prices when they are uncertain about how
many patients they might have, even when they are dealing with known
entities like the large health insurers.
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In addition, Americans next month are due to start buying their
plans for next year during open enrollment, whether that is through
an employer or on their own.
That means 2018 would be off the table for the executive order's
provisions.
2019 AT THE EARLIEST?
"To get ready for 2019, you would have to be fairly up and running
by the spring or early summer, and you would have to have things in
place for the employers who would want to sell coverage for a 1/1
date," Dillon said, referring to Jan. 1, 2019.
By the time April rolls around, health insurers like Aetna Inc and
UnitedHealth Group Inc and benefit design brokers like Aon PLC and
Mercer, part of Marsh & McLennan Cos., are shopping around plans for
2019 with the goal to sign contracts by the summer. That gives them
time to create the advertisements and documents that go to employees
in time for sign-up.
The 2019 plans would go on sale in November 2018.
WHAT ELSE COULD MESS THIS UP?
Legal challenges from Democratic state attorneys general who have
fought some of Trump's initiatives could further delay associations
from forming, or employers from deciding to move employees from
current small group plans or to offer a plan to employees currently
being served by the individual market.
(Reporting by Caroline Humer; Editing by Will Dunham)
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