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What APA is Doing For You: Fighting to Protect Patient Protections in Insurance Law

     

The American Psychiatric Association (APA) recently filed suit along with several allied groups in the U.S. District Court for the District of Columbia to invalidate the short-term, limited-duration insurance (STLDI) plan rule issued last month by three federal agencies. The STLDI rule undermines consumer protections for those with pre-existing conditions and could open the door for insurers to engage in practices that discriminate on age, gender or health status.

We filed this suit along with the Association for Community Affiliated Plans (ACAP), National Alliance on Mental Illness (NAMI), Mental Health America, AIDS United, National Partnership for Women & Families, and Little Lobbyists. All of these groups are committed to ensuring that patients are able to access quality, affordable health care with full parity for mental health and substance use disorders, free from coverage limits and other abusive practices that are explicitly prohibited by the Affordable Care Act (ACA).

We are united on this point because it is extremely important that patients with complex health needs receive the care they need when they need it, without the process devolving into a stressful waiting game to see whether a potentially life-saving claim will be denied.

A proliferation of short-term, limited duration plans such as those in the STLDI rule would threaten the vital peace of mind that comes with strong, predictable health coverage by opening the door for many practices that were banned by the ACA.

These short-term skinny plans will allow insurers to set higher premiums based on age, gender, and health status, deny access to basic benefits, undermine catastrophic protections, deny coverage for any pre-existing condition, and increase uncompensated care for health care providers. The result is that many patients who would have been otherwise covered will end up in the emergency room, raising health care costs and worsening outcomes. Those with comprehensive coverage will see their premiums increase, while healthy people will be lured out of quality plans in favor of short-term plans without consumer safeguards.

In our view, the STLDI rule also violates the law. In our court filing, we argue that the STLDI rule violates the plain-English meaning of “short-term” by defining it as 364 days instead of three months, as currently allowed, and “limited duration” as up to 36 instead of 12 months. We are confident that this fact, along with the rule arbitrarily reversing limits set on these plans by the ACA, will result in the court agreeing that the rule is unlawful.

Comprehensive and affordable insurance coverage for all health issues, including mental health and substance use disorders, is of paramount importance to our nation, especially during a time when opioid overdoses and suicides have reached epidemic proportions. The APA and our allies will continue to fight against a return to the predatory insurance practices outlawed by the ACA, and work to ensure the patient protections and essential care benefits it enshrined into law are protected.

What APA is Doing for You

This blog post is part of an occasional series highlighting how APA advocates on your behalf to support the profession of psychiatry and put our interests before key policymakers.

     

Post by Saul Levin M.D., M.P.A.

Saul Levin, M.D., M.P.A., FRCP-E, is APA's CEO and Medical Director. Read Dr. Levin's full biography

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What APA is Doing for You

 

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