Non-Obamacare health plans may soon be available in Puerto Rico. This is great news as consumers will have the freedom to choose better-fitting health care plans than wasteful, overpriced Obamacare health care plans. Don’t forget how President Obama lied when he said, “if you like your health insurance plan, you can keep it.”
Issued : Tuesday, April 14, 2015 12:00 AM
This bill paves way for health plans that don’t comply with ACA
By : XAVIRA NEGGERS CRESCIONI
Insurance commissioner submits draft of bill to La Fortaleza
Insurance Commissioner Ángela Weyne has submitted to La Fortaleza a draft of proposed legislation that would enable local insurers to issue some health plans that don’t meet the Patient Protection & Affordable Care Act of 2010 (ACA or Obamacare) requirements for 10 essential health benefits (EHBs) insurers must cover.
“We are doing this to provide options for people who are cash-strapped and prefer to have a health plan that lacks certain coverage, but is cheaper compared with a more expensive ACA-compliant plan,” Weyne said. “This way, people will have more choices for their coverage and financial needs.”
Puerto Rico can do this under local law because the Health Resources & Services Administration (HRSA) basically eliminated ACA’s mandatory application to Puerto Rico in a letter the agency issued last July. At that time, the HRSA based its decision to exempt Puerto Rico from ACA’s mandates on the commonwealth’s decision to use ACA funding to beef up its Government Health Plan, which covers 1.7 million medically indigent people, and not require people to have health insurance under the law or individual mandate.
While the HRSA eliminated the commonwealth’s required compliance with ACA, the Puerto Rico Insurance Commissioner’s Office has maintained all ACA requirements, with the exception of the individual mandate and year-round insurance exchange. Replacing these two requirements was the local requirement that local insurers must provide various levels of coverage under ACA-compliant plans—varying from 10% to 40% copays— during an annual mandatory subscription period from October through December.
Under the proposed legislation, insurers will have to offer at least two ACA-compliant plans and, in addition, may offer “alternative plans,” which may not cover all 10 EHBs.
The 10 categories that must be covered under plans that meet ACA requirements are: ambulatory care; emergency services; hospitalizations; lab services; maternity & newborn care; mental health & addiction treatment; rehabilitative services; pediatric care; prescriptions; and preventive wellness & chronic disease treatment. Insurers also have to include this coverage, with no caps on treatment or tests.
“Most likely, people will opt for plans that don’t include prescription medication since this tends to push up the plan’s price quite a bit, and probably this legislation won’t apply to plans during this year’s mandatory subscription period, but rather to mandatory subscription next year,” said Marielda Jiménez, deputy Insurance commissioner in charge of legal affairs.
ACA-compliant and alternative plans in the individual small employer markets will be considered in a single risk pool for rate purposes, Weyne said.
Under the bill, commercial insurers will have to continue to provide at least two ACA-compliant plans during the local subscription period from October through December of each year.