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Life Health > Health Insurance > Your Practice

Regulatory burden review

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It’s hard to know what Trump administration officials were thinking when it changed federal border control rules with an executive order Friday.

Administration officials have said they wanted to surprise potential evildoers with the rule-change, in an effort to keep those malefactors from trying to rush into the United States during a transitional period. Others have suggested that the administration might have imposed a very tough version of the new rules in an effort to make a milder version stick.

Whatever the administration’s reasoning, I think the effects of the sudden change on public opinion shows why agents, brokers, employers and insurers should be encouraging federal policymakers to use an orderly, inclusive process when de-funding, changing, repealing or replacing the Affordable Care Act.

Related: Trump may end ACA insurance requirement, Conway says

New rules governing refugees and travelers from places like Iraq affect only a relatively small number of people, and few of us know many people from those places.

New rules governing individual health insurance could affect about 20 million people, and most of us know some of those people. Some of us are those people.

It seems as if responding to a major new change in product rules takes a typical health insurer at least about 18 months.

The introduction of the Affordable Care Act major medical rules is itself an example of how difficult changing the health insurance system is. President Barack Obama signed the two bills that created the ACA in March 2010. Government officials and insurers had until Oct. 1, 2013, to get used to the new rules. But that was barely enough time for them to get the new system up and running.

The new TrumpCare system might be much simpler. But even if the federal government replaced the ACA with a federal law that tells insurers, “Do what feels good,” and prohibited states from imposing any other rules, insurers would still need time to update forms and computer systems, revive medical underwriting operations, and think deep thoughts about what claims might be like.

Agents and brokers would need some time to remember how to get clients through individual major medical underwriting.

Underwriters and consumer information services would need time to build the kinds of connections that now link the life insurers and the information services.

A system that let the nimblest insurers switch to the new system whenever they wanted, while somewhat slower insurers were still operating under the new rules, could kill off the somewhat slower insurers.

Especially in states that had relied almost entirely on the federal government to handle major medical regulation, there might be a period in which little or no individual major medical coverage would be available.

In the real world, many state and federal rate-setting and form filing requirements would probably stay in effect. Any collisions between the joys of freedom and the wire cords of filing requirements could slice insurers’ heads off.

If, for example, insurers enjoy many wonderful new freedoms, but can only change their rates once a year, that could be fatal.

If policymakers free individuals and employers from every conceivable annoying ACA rule, but keep the rules that tie up insurers, that could be fatal.

The protests that erupted when people realized their spouses could no longer get reliable access to treatment for diabetes or cancer might be much bigger and more disruptive than the recent wave of Trump travel ban demonstrations.

One solution would be to quickly establish guidelines creating a post-ACA transitional period.

Policymakers in Washington could agree now, long before they know what exactly they will do to the ACA system, that they will keep the current rules in effect at least through the end of 2018, and give everyone at least 18 months after major ACA change or replacement legislation is signed to adapt to the new rules.

Moreover, policymakers could agree to put any new system through a thorough burden review process, and to take the commenters seriously. Maybe insurers, doctors, patients and other interested parties could come up with great ideas for making any new system work better.

Agreeing ahead of time to a transitional period and a thorough burden review process would give everyone the time to switch to the new system in an orderly, productive way, rather than turning doctors, hospital workers and armies of people with health problems into picketers.

Allison Bell is a senior editor at


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