The Trump administration has released its final rule expanding so-called association health plans. The rule would allow many consumers to avoid some of ObamaCare's unwanted regulatory costs. But the rule also highlights both the destructive power of ObamaCare and Republicans’ utter lack of imagination when it comes to health care.
As originally proposed, the idea behind association health plans was to allow small businesses that purchased health insurance through a member-organization (i.e., an association) to enjoy the same federal exemption from insurance regulation that large businesses have traditionally (if unwisely) enjoyed. Small businesses have long wanted that exemption so they could escape oppressive state regulation. Now, small businesses are clamoring for association health plans because they want to escape oppressive federal regulation.
ObamaCare exempts large-employer health plans from many of the regulations it imposes on small-employer plans. The new rule treats association health plans like large-employer plans for purposes of ObamaCare, which allows small employers who purchase health insurance through a member organization to avoid those costly regulations. The consulting firm Avalere estimates the ability to avoid some of ObamaCare's unwanted regulatory costs would induce 3.2 million people to enroll in association health plans and reduce their premiums:
Premiums in the new AHPs are projected to be approximately $2,900 a year lower compared to the small group market and $9,700 a year less compared to the individual market.
By Grabthar's hammer, what a savings!
Traditionally, association health plans have always been a terrible idea that violates Republicans’ federalist principles, because they would move health-insurance regulation from the state level to the federal level. But since ObamaCare went ahead and federalized regulation of small-business health plans, and the association-health-plans rule merely allows small businesses to opt for lighter versus heavier federal regulation, association health plans no longer violate federalism. Credit ObamaCare with making a bad idea good.
Even in this iteration, however, association health plans still aren't much of a good an idea. Trump’s association health plans rule builds on the broken model of employer-sponsored health insurance. Employer-sponsored coverage is lousy coverage. It deprives workers of control of their health-insurance dollars and decisions. It sticks millions of workers with health plans they would never choose themselves. It leaves millions of workers with uninsurable preexisting conditions, because it disappears for no good reason after workers get sick. It increases prices for health care and health insurance. The failures of our government-created system of employer-sponsored coverage are what created the demand for ObamaCare in the first place. Rather than offer an agenda to make health care better, more affordable, and more secure, Trump's association health plans rule works entirely within that framework. It does nothing to move Americans toward a better system of providing health insurance.
Still, it would allow some workers to avoid some unwanted regulatory costs. So there's that.
And that part gives rise to the only other good part of this rule, which is also the part that ObamaCare supporters hate the most: the rule will make ObamaCare's costs more transparent. ObamaCare imposes its highest hidden taxes, in the form of higher premiums, on the healthy. The association-health-plans rule will free an estimated 1 million disproportionately healthy people to escape those unwanted regulatory costs. When those folks drop out of the Exchanges, the average risk in ObamaCare's risk pools will rise. Correspondingly, ObamaCare premiums will rise, perhaps even faster than they have to date.
ObamaCare supporters decry this as "sabotage," but that is a subterfuge. When ObamaCare premiums rise to reflect the cost of ObamaCare's regulations, it is what the world calls transparency. ObamaCare supporters fear such transparency because, as ObamaCare architect Jonathan Gruber admitted, the public would have rejected the law (and still might!) if they could actually see what it does. "[If] you made explicit that healthy people pay in and sick people get money," Gruber admitted, "it would not have passed."
And if you reach a point where you decry transparency as sabotage, it may be time to reevaluate your life.