Market Stabilization 

Learn more about why we advocate for individual health insurance market stabilization, including the solutions we endorse and current legislative trends. 

The Issue

  • While the majority of our health care system is stable, more must be done to protect people with pre-existing conditions like arthritis in the individual insurance market.
  • Since 2013, many state exchange marketplaces have seen premiums increase over time. Patients have also seen increasing out of pocket costs. Insurance providers (insurers) have made these changes in large part because healthier individuals have chosen not to enroll in plans offered on the marketplace. 
  • In addition, the federal government decided to end payments that compensate insurers for covering individuals that use more health care services. 
  • Short-term Limited Duration Health Plans – Short-term, limited duration (STLD) health plans offer less coverage than a typical comprehensive health plan and only provide coverage for a limited amount of time. As a result of the limited coverage, these plans can leave patients without insurance for major medical expenses like prescription drugs and hospital care. These plans are exempt from Affordable Care Act (ACA) protections against discrimination on the basis of pre-existing conditions (such as arthritis) and may exclude coverage for expenses as a result of that condition.
  • Association Health Plans – A 2018 regulation from the federal government provided additional flexibility to associations and small employers so they could sell plans that are exempt from many ACA protections. These plans cannot discriminate against individuals with a pre-existing condition; however, they can vary premiums based on age, gender, or a patient’s geographic location. Historically, these types of plans have been found to be deceptively marketed and increased risk of insolvency.
  • State-Based Individual Mandate - In November 2017, with the passage of tax reform legislation, Congress repealed the tax penalty for not having health insurance. Without a federal requirement that individuals maintain health insurance, people will likely delay signing up for insurance until they need it. If healthy individuals do not participate in the marketplace, insurers will compensate by raising premiums and making health care coverage unaffordable for Americans who do not qualify for tax subsidies.
  • Section 1332 Innovation Waivers - Section 1332 of the ACA permits states with unaffordable or few insurance options sold on their marketplaces to experiment with innovative ways to deliver health insurance to individuals so long as certain guardrails are in place.

The Solution

  • Increased transparency for short-term plans and association health plans, a healthy risk pool, and the introduction of reinsurance programs to help insurers cover claims for high-cost patients.
  • Short-Term, Limited Duration Health Plans – Require clear transparency from plans on what benefits are covered and are not covered, especially prescription drug coverage. Limit the availability of short-term plans or limit contract duration and restrict how often they can be renewed. These important protections will help ensure that STLD plans remain available as transitional, limited coverage options for people between jobs or in other extenuating circumstances, while also making clear that these plans do not constitute true health care coverage.
  • Association Health Plans – Require association health plans to meet the same requirements for covering the ACA’s essential health benefits and other important patient protections. Require transparency from plans on what benefits are covered.
  • State Based Individual Mandate – To lower premiums and out of pocket costs, encourage states to enact their own individual mandate that requires everyone to participate in the marketplace or pay a tax penalty or fine. Studies show that states with marketplaces that have participation from those with low health care needs often have lower premiums and out of pocket costs.
  • Section 1332 Innovation Waivers – Encourage states to address rising premiums in their marketplaces by creating a state reinsurance program. A reinsurance program provides payments to insurers to help pay claims for high-cost enrollees. From Alaska to Maine, states have found success in balancing their insurance markets by creating reinsurance programs. These payments are made after an insurer’s costs are unexpectedly higher than anticipated.  

Current Trends

  • Congress is considering legislation that would nullify recent federal regulations that expanded short-term, limited duration health plans (H.R. 1010). 
  • A recent court ruling in March 2019 questioned the expansion of association health plans by the federal government. The court directed the Department of Labor to revise the regulation to satisfy the court's ruling. It is likely the ruling will be appealed. 
  • Some states are considering state wide individual mandates; California is the only state, to date, that has enacted such legislation.
  • Seven (7) states have approved Section 1332 Innovation Waivers by the federal government. Several additional states have draft waivers under review. 
Storybank

Share Your Story

Have you experienced this in your care journey?

Share Today
Advocate for What's Right

As an Arthritis Advocate, you’ll feel good about taking action to make health care more accessible. Help shift the policy and public perception that affects those living with arthritis.

I Want to Contribute
I Need Help
  • Donate

    Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life.

  • Volunteer

    Join us and become a Champion of Yes. There are many volunteer opportunities available.

  • Live Yes! INSIGHTS

    Take part to be among those changing lives today and changing the future of arthritis.

  • Partner

    Proud Partners of the Arthritis Foundation make an annual commitment to directly support the Foundation’s mission.

Donate


Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20. You'll receive a year's worth of Arthritis Today magazine, access to helpful tools, resources, and more.

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We'll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Volunteer


Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.


More About Volunteering

Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 


How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Get Started

 

Partner


Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

Supporting

Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.

More About Partnerships