PPACA Implementation (AP Photo/Jacquelyn Martin)

A health law expert who represents consumers in proceedings at the National Association of Insurance Commissioners (NAIC) says there are many loopholes in the Patient Protection and Affordable Care Act of 2010 (PPACA).

Timothy Jost, a law professor at Washington and Lee University and a consumer liaison representative at the NAIC, Kansas City, Mo., gave a presentation on PPACA loopholes earlier this month at the NAIC’s fall meeting in National Harbor, Md., during an NAIC/Consumer Liaison Committee session.

In a copy of a written version of the presentation posted on the committee’s website, Jost says some of the types of coverage not governed by PPACA include:

  • Retiree-only plans.
  • Short-term health plans.
  • Health care sharing ministries.
  • Specified-disease plans, such as critical illness plans.
  • Hospital indemnity products and other fixed indemnity products.

Many health insurers want to find ways to escape PPACA protections so that they can “continue to risk select, eliminate or limit the effects of the risk pooling mechanisms in the legislation, avoid the consumer protections in the legislation, offer inadequate coverage [and] deceive consumers,” Jost says in the written presentation.

Selling stop-loss programs — reinsurance for health plans — to very small employers is another way for companies to get around PPACA, Jost says.

Jost would like to see states ban the sale of stop-loss coverage to small groups, or else raise the “attachment point,” or stop-loss deductible, to a high enough level to discourage small groups from reinsuring simply to escape PPACA requirements.

Jost also would like to see states either require products such as critical illness insurance and hospital indemnity insurance to meet PPACA requirements or else require the sellers of the products to disclose that the products are not subject to PPACA.

Regulators also should monitor health care sharing ministries and short-term health plans for abuses, Jost says.