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Health Insurers Want More Time For Trump's HRA Proposal

By John Commins  
   January 03, 2019

AHIP wants the effective date of the final rule to be pushed back by 18 months or more, claiming the one-year timetable proposed by the Trump administration "is insufficient to allow Integrated HRAs to be properly designed, offered and administered."

Commercial payers are urging the federal government to delay by at least a year-and-a-half proposed rules to expand the use of Health Reimbursement Arrangements.

"As with any change of this size and complexity, adequate planning time is required," Keith Fontenot, executive vice president, Policy and Strategy, at America's Health Insurance Plans said in his letter to the secretaries of Treasury, Labor, and Health and Human Services.

"We recommend the effective date be no earlier than January 1, 2021, or 18 months following publication of the final rule, whichever is later," Fontenot said.

The call for a delay was one of six points stressed by Fontenot in his letter, which generally was in support of HRAs "if properly regulated and implemented."

"Access to new HRA options will give employers and consumers more choices on where to get their health insurance," he said. "With proper safeguards and careful planning, HRAs will create new opportunities for businesses of all sizes to offer new coverage options to their employees while strengthening the individual market with new potential enrollees."

"However, enforceable safeguards and non-discrimination protections are essential for these options to work for Americans. Clear rules on when an HRA can be offered, what types of plans can be purchased using these funds and on what terms will be key," Fontenot said.

The Trump administration's HRA proposed expansion has received relatively good reviews for its protections against adverse selection since it was unveiled in late October.  

"What leapt off the page for me after reading the proposal was how much they cared about protecting the individual market from adverse selection," John Barkett, who served in the Obama administration's Office of Health Reform, told HealthLeaders.

"They were very concerned about putting this rule out in a way that wouldn't let employers send their sickest workers into the individual marketplace," he says.

In addition to the 18-month delay, AHIP called for:

  • Strong non-discrimination provisions to protect consumers with pre-existing conditions and to promote access to affordable coverage. While the proposed rule "recognizes these goals," Fontenot urged the federal government to strengthen protections in the final rule. "Any weakening of these protections risks significant harms for both the individual and employer provided coverage markets and the members they serve," he said.  
  • Prohibiting the use of Integrated HRAs to purchase short-term, limited duration insurance. "We strongly believe that an Integrated HRA as a benefit offering should reimburse only major medical coverage," Fontenot said. "Such coverage will protect consumers from financial harm upon an illness or injury and ensure a balanced risk pool."
  • Protecting employer provided coverage and supplemental benefit offerings. "We ask the agencies to consider the impact of these new arrangements on employer-provided coverage and how to best advance innovations across market segments," Fontenot said.
  • Ensuring coverage is affordable for employees. "We are concerned about scenarios where some employees would have paid less for coverage due to eligibility for the premium tax credit," Fontenot said.
  • Preserving HIPAA excepted benefits to ensure access to health coverage that promotes financial security for specific needs. "We appreciate the proposed rule creates a new type of HRA to expand access to Excepted Benefits. However, we urge the tri-agencies to allow reimbursement from an Excepted Benefit HRA only for existing HIPAA Excepted Benefits, which do not include short-term, limited duration insurance," Fontenot said.


“We recommend the effective date be no earlier than January 1, 2021, or 18 months following publication of the final rule, whichever is later.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


AHIP calls for final rule on HRAs to take effect no sooner than January 1, 2021.

Commercial plans want strong non-discrimination provisions for pre-existing conditions.

The payers call for a prohibition on the use of Integrated HRAs to purchase short-term, limited duration insurance.

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