Thread by @charles_gaba

📣 Tonight is Christmas Eve, so here's a thread about a so-called "Christian Health Sharing Ministry" which dives into Inception-level surreality. 1/

"Health Sharing Ministries" (usually offered by "Christian" organizations but occasionally via non-Christian groups) are promoted as an alternative to actual health insurance policies. They've become much more popular since the #ACA became law because they're less expensive. 2/

HOWEVER, there's some REASONS why they're less expensive than #ACA-compliant policies:

"Although HCSMs are not insurance & DO NOT GUARANTEE PAYMENT OF CLAIMS, their features closely mimic traditional insurance products, possibly confusing consumers." 3/

commonwealthfund.org/publications/f…

Last year, the @commonwealthfnd posted a follow-up regarding their concerns about HCSMs...and about one particularly nasty company which operates under multiple brands: Aliera, aka Trinity Healthcare: 4/ chirblog.org/aliera-healthc…

Let me repeat: HCSMs *ARE NOT HEALTH INSURANCE*...which means they aren't regulated or licensed as such...but since the #ACA, they've started *mimicking* ACA-style health insurance in their marketing/advertising: 5/

Now, *some* HCSMs *may* be on the up & up. But some aren't...and Aliera/Trinity in particular sure as hell seems to come up a lot.

May 2019: Washington State: 6/
acasignups.net/19/05/13/washi…

7/

May, 2019: New Hampshire: 8/
acasignups.net/19/05/14/new-h…

9/

December 2019: Connecticut: 10/ ctpost.com/local/article/…

11/

April 2020: Missouri: 12/
insurancejournal.com/news/midwest/2…

13/

October 2020: New York: 14/
courthousenews.com/christian-grou…

15/

And finally, this morning: New Jersey: 16/

acasignups.net/20/12/24/new-j…

17/

OK, so Trinity/Aliera sure as hell appear to be Bad News, yes?

Now, let's talk about California. This post is from a year ago, so the situation might have changed since then: 18/ acasignups.net/19/12/06/calif…

As I note in this video, there's about a half-dozen types of "healthcare plans" which are NOT #ACA-compliant (or which technically are w/major caveats): Grandfathered, Grandmothered, Shring Ministries, Farm Bureau, Short-Term and Association Plans. 19/

(In the video I also listed "Student Plans" here but I shouldn't have...those ARE fully #ACA compliant, they just have some special exceptions due to their nature...I'm actually enrolled in a student plan myself, in fact, as I explained here): 20/ acasignups.net/20/08/28/updat…

I lump the other 6 types into the hashtag #ShortAssPlans, but it really just refers to any non-ACA compliant policy which leaves major holes in coverage...and some have a long history of fraud/deceptive practices.

The Trump Admin, of course, promotes the hell out of those. 21/

Anyway, California, which is VERY much PRO-ACA, was deeply concerned about #ShortAssPlans. Some states have countered Trump's attempts to promote them (especially so-called "Short-Term, Limited Duration" plans) by restricting them. California BANNED THEM outright. 22/

At the same time, California also added their own enhanced/expanded subsidies to cut down the cost of premiums for ACA-compliant plans via @CoveredCA, which also helps reduce the *demand* for #ShortAssPlans. 23/

...and this brings me to the main point of this thread: This post of mine from a year ago: 24/ acasignups.net/19/12/06/calif…

There are 16 *official* #ACA enrollment websites:
--HealthCare.Gov for residents of 36 states
--CoveredCA.com for California
--CO, CT and 13 other states each have their own official state-based ACA exchange

In addition, however, there are *authorized* 3rd-party sites. 25/

These *authorized* 3rd-party web brokers are called "Direct Enrollment" entities (DEs) or, in some cases, "EDEs" (Enhanced Direct Enrollment). They're private insurance brokers OK'd to sell on-exchange #ACA policies. They're allowed by the ACA & have been around since 2014. 26/

TO BE CLEAR: I'm fine with DEs/EDEs in my book as long as they're fully ACA compliant, *only* list ACA policies and make sure to list *all* ACA policies side by side, just like the official sites do.

Disclosure: One which meets these criteria has a banner ad on my own site. 27/

OTHER DEs and EDEs, however, may not be so scrupulous. @TaraStraw wrote up a detailed list of concerns about these to look out for last year: 28/ cbpp.org/research/healt…

OK, back to California. Like HCgov and other state-based exchanges, @CoveredCA has some authorized private brokers/agents who help sell their policies.

One of them is called "Health for CA Insurance Center" based out of Santa Rosa. So far, so good. 29/

Last year, however, I noticed two very odd things on Health for CA's website (besides the actual @CoveredCA logo at the top, which I guess is allowed as long as it's side by side with their own logo):

It bothered me that they sell short-term plans (STLDs) side by side w/ACA plans...but that's allowed for DEs. I don't like it, but it's legal.

More concerning: How can they sell STLDs in CA when CA had banned short-term plans?

And finally, Aliera being listed is Bad News. 31/

And here's where it gets trippy: ENHANCE!!

"Aliera Healthcare is a Health Sharing Plan and is not offered through Covered California."

Hmmmm.... 32/

But even more interesting, if you click on the "Short Term Plan" link, it said this: 33/

Aside from some minor quibbles, the last bit is key:

"Now, short-term coverage is back again, although it can no longer be called insurance. Instead, short-term coverage is now offered as short-term health plans."

Ummmm...ok... 34/

And this is where Aliera came in: 35/

In other words--stay with me here--they WEREN'T selling *actual* Short-Term, Limited Duration plans. (which are illegal in CA now).

They were instead offering Healthcare Sharing Ministry plans (which *are* legal) but *labelling* them as "Short-Term Plans" (which *aren't*). 36/

Now, I've heard of plenty of cases of companies selling ILLEGAL products while presenting them as being LEGAL...but I've never before heard of a company selling a LEGAL product while billing it as being something that's ILLEGAL.

That's just...strange. 37/

FURTHERMORE, "Health for CA" bent over backwards to make sure everyone knew how limited these plans were. All of this is taken from their website last year and none of it was buried; it was quite prominently displayed: 38/

In fact, Health for CA seemed to be doing everything possible to DISCOURAGE anyone from buying Aliera's HCSM-branded-as-STLD plans short of, you know, not offering them anymore: 39/

Here's where things stood as of a year ago. Try to follow along: 40/

Whew.

Now, HERE'S THE GOOD NEWS: The state of California and @CoveredCA itself was well aware of this issue, and in fact CA Insurance Commissioner @ICRicardoLara joined other states in ordering a Cease & Desist Order to...Aliera/Trinity earlier this year: insurance.ca.gov/0400-news/0100…

As for the issue of @CoveredCA's certified agents (such as Health for CA) selling non-compliant plans, especially HCSMs, they had several meetings and took some votes on how to deal with that situation: 42/
board.coveredca.com/meetings/2019/…

...and implemented the following policy changes starting this year: 42/

board.coveredca.com/meetings/2019/…

With all that in mind, I decided to take another look at the "Health for CA" website to see what changes have been made...and there's quite a few.

For starters, guess who's no longer listed at all? Aliera. 43/

The other major change? Well, there's still a "Short-Term" *LINK* at the bottom of the page...but when you click it, the text is COMPLETELY different now: 44/

As far as I can tell, HealthforCalifornia.com no longer offers HCSMs from Aliera/Trinity, is no longer labelling HCSMs as STLDs, and is no longer offering HCSMs *or* STLDs *at all*...which is why I'm finally linking to their site in this tweet so you can see for yourself. 45/

ALL OF THIS BRINGS ME TO THE *REAL* POINT OF THIS THREAD: Trump's @CMSGov #NBPP2022, which was released a few weeks ago: 46/ acasignups.net/20/12/02/updat…

The NBPP is an annual list of assorted proposed tweaks/policy changes in how the ACA is implemented and enforced. Some of these are major, some are minor. Some are perfectly reasonable...and some are terrible ideas. 47/

FOR NOW, these are just *proposed* changes. CMS has to allow for a PUBLIC COMMENT PERIOD...which we're in the middle of. They're then supposed to READ, REVIEW and RESPOND to every single comment before going forward with the proposed changes for the following year. 48/

This year, there's over a dozen proposed changes in the NBPP, and again, many of them are fine or are innocuous...but several are simply TERRIBLE IDEAS, and two of the terrible ones related directly to this thread. 49/

🚨 FIRST: Until now, DEs/EDEs have been *tacitly* allowed to also list #ShortAssPlans alongside ACA plans...they were neither approved nor forbidden. @SeemaCMS is now proposing to *officially approve* doing this...as well as letting them *hide some info* about ACA plans: 50/

🚨 SECOND: @CMSGov is *also* now proposing to let individual states simply OPT OUT OF USING AN OFFICIAL #ACA EXCHANGE AT ALL. I don't just mean moving from HC.gov to their own state exchange (as NJ & PA did this year). I mean NOT USING *ANY* ACA EXCHANGE. 51/

.@SeemaCMS is *already* letting GEORGIA do this via a legally-strained Section 1332 Waiver authorization...but that doesn't happen until 2023, so the Biden Administration via new HHS Secretary @XavierBecerra *SHOULD* be able to reverse this before it goes into effect. 52/

However, if the proposed #NBPP2022 change were to be approved and implemented, it would mean ANY state could effectively privatize the ACA exchange *entirely*. That wouldn't mean HC.gov *plus* private 3rd-party brokers; it would mean ONLY private brokers. 53/

IF YOU'VE MADE IT THIS FAR IN THE THREAD, you can see what a disaster this could become, especially in states where the ACA is, shall we say, less than beloved by state officials & regulators.

🚨 FORTUNATELY, you can help stop this by SUBMITTING A PUBLIC COMMENT *RIGHT NOW*! 54/

🚨 As @StanDorn has noted, Public Comments in opposition to Medicaid work requirements played a MAJOR role in the federal court decisions striking them down in several states this year.

GO HERE *NOW* TO SPEAK OUT AGAINST THESE TWO PROPOSALS (be polite):
federalregister.gov/documents/2020…

🚨 THE DEADLINE TO SUBMIT PUBLIC COMMENTS IS MIDNIGHT ON 12/30/20...just six days from today.

Remember: Be firm but also polite. As of this writing there's only 71 comments...feel free to review them to get a feel for how these are typically worded:
federalregister.gov/documents/2020…

There are problems with some of the other proposals as well, but these are the ones which are probably the easiest for non-wonks to understand. I'll be addressing them and others in a blog post soon. /END.