Congress has recently made sweeping changes in healthcare insurance legislation, particularly in short-term coverage laws, which are expected to take effect in 2019. Most of these changes will create greater options for consumers when choosing healthcare coverage and at the same time help them save money while eliminating tax penalties.

Given the dramatic public debates and easing of restrictions in existing legislation, consumers are likely to see more choices as insurers are expected to offer a variety of coverage options in 2019. You can expect to see ever-greater changes in the healthcare insurance market as insurance carriers take advantage of laws that are friendlier to their business model.

Healthcare insurance is expected to be a hot political topic in 2019 and again in 2020, when voters return to the polls to select a president. Democrats won many races in the 2018 midterms on the healthcare issue and, as the House of Representatives shifted left as a result, we can expect much more discussion on the subject of healthcare reform.

Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA), more usually known as the Affordable Care Act (ACA) or by the nickname “Obamacare,” is a federal law enacted in 2010—after much debate and deliberation in Washington. It was the most significant and controversial healthcare legislation since the passage of Medicare and Medicaid some 46 years earlier.

The ACA went into effect in 2014 and introduced many reforms to the industry as well as radically altered the marketplace. It generated plenty of harsh criticism, but opponents focused primarily on two provisions outlined in the ACA.

First, consumers were mandated to have either an employer-sponsored plan or their own policy carrying “minimum essential coverage” to avoid paying a penalty—unless they were granted an exemption. Second, insurers were required to provide “essential health benefits,” which were standards set by the government that required every plan meeting ACA provisions for acceptable coverage to include certain services.

These standards included:

• Ambulatory patient services (also known as outpatient care)
• Emergency services
• Hospitalization
• Maternity care and newborn care
• Mental health and substance use disorder services including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services including oral and vision care

Obamacare requirements also banned annual or lifetime coverage caps. Critics felt that the law was too restrictive and that it forced consumers into policies they couldn’t afford because it included many benefits they may have neither needed nor wanted. For instance, unmarried men often complained about expensive maternity coverage being part of their healthcare plans. Also, short-term health plans didn’t meet the guidelines.

As the marketplace evolved, others complained about a lack of insurers and the rising costs of premiums. In some states, premiums skyrocketed and became unaffordable.

What’s Changed in 2019

After much debate and public input, Congress did away with the individual mandate, also known by the more formal “individual shared responsibility provision.” This required that individuals and families carry a minimal amount of health insurance, with a few exceptions.

Those who failed to meet the requirement were required to pay a penalty, called the “individual shared responsibility payment,” or seek an exemption. Congress repealed this provision in 2017, but the law didn’t take effect until 2019.

This repeal has opened the doors to new options for coverage and created greater availability. One choice allows people to obtain policies for a shorter period of time and not have to go through the marketplace or depend on their employers.

The law came about when the federal government eased restrictions on short-term health insurance. These short-term plans originally started as temporary policies for those who were waiting to enroll in an ACA plan or while waiting for employer-sponsored coverage to begin.

Many times, these plans were less expensive than those found in the marketplace. This was due to short-term plans not having to provide comprehensive benefits or guarantee coverage for preexisting medical conditions.

Insurers can now offer short-term plans for longer periods of healthcare coverage, which had been limited to three months under the ACA. With the repeal of the individual mandate, many more people are expected to flock to this type of coverage.

With easier access to these programs, consumers now have a much wider selection of benefits and plans to choose from. Short-term plans will allow individuals and families to customize their healthcare coverage.

These plans are not one-size-fits-all, however. They usually don’t cover preexisting conditions and don’t provide essential benefit coverage.

Consumers are cautioned to carefully review short-term healthcare benefits, conditions, and terms before enrolling in any plan.

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Short-term medical plans have transformed the Affordable Care Act (ACA) for consumers seeking a way to pay the growing cost of healthcare. More Americans are taking advantage of healthcare coverage provided by short-term medical plans instead of participating in the government healthcare marketplace exchanges.

These short-term medical plans were originally offered for those who expected to be out of an existing healthcare plan for a brief period such as during a job change or while waiting to become eligible for Medicare. Unlike ACA-compliant marketplace plans, short-term medical plans don’t come with comprehensive benefits or guaranteed coverage for preexisting conditions.

While these temporary plans are customized to an individual’s needs, they may fall short if you experience an unexpected illness or injury. Even with coverage, short-term medical plans can leave the insured at risk for financially devastating medical bills if they don’t choose carefully.

Short-term medical plans do have one thing consumers want. They often come with premiums that are MUCH less expensive than healthcare plans offered on the marketplace exchanges.

Rising premiums may be the single strongest driving force behind most consumer decisions to leave ACA plans. From 2016 to 2017, average monthly premiums increased 18 percent for individuals with coverage through the exchange.

Some states saw premiums skyrocket. Marketplace consumers in Arizona saw their premiums increase a whopping 116 percent in 2017.

Recent Changes

In recent month, Americans have experienced shifting perceptions of the ACA and what’s deemed essential for consumers to meet their healthcare insurance needs. Whether coverage is even necessary may be another issue facing Americans considering that the first 30 days of the sign-up period have undergone a drop of 11 percent over the previous year’s enrollment.

Only about 3.2 million people enrolled during that first month or about 400,000 fewer than in the previous year. These numbers are surprising given that healthcare was the most popular issue among voters in the 2018 midterm elections.

The ACA’s Open Enrollment starts November 1 and runs through December 15. Consumers who miss choosing healthcare in the marketplace exchange can take advantage of a Special Enrollment Period (SEP).

SEP opens up when people have a qualifying event that allows them to obtain insurance through the marketplace. This is usually for 60 days after they become eligible due to their individual circumstances.

Qualifying events are numerous and include the loss of employer-sponsored insurance, divorce, aging out of a parent’s plan, or losing coverage on a government program such as Medicaid, among many others. However, it seems that many consumers are seeking options with lower monthly costs and trying to avoid the exchanges altogether.

Even with the availability of federal subsidies, not everyone is willing to pay the higher premiums that come with an ACA-compliant major medical plan. According to data by eHealth, an online private healthcare plan exchange, during the first half of Open Enrollment for 2018, 56 percent of the company’s customers opted for short-term coverage, and 44 percent selected plans without government subsidies.

End of a Mandate

The sluggish participation in the federal government’s platform, healthcare.gov, is likely due to the repeal of the ACA provision known as the “individual mandate.” Another provision of the law that was changed was the definition of “short-term,” which transformed from less than 90 days to a year. In fact, some policies may now be renewed for up to three years.

This controversial individual mandate required that most consumers purchase healthcare or pay a penalty—unless they managed to obtain an exemption. This unpopular portion of the ACA was repealed in 2017 with passage of the Tax Cut and Jobs Act, after several failed attempts at a full reform of the legislation.

Due to legal challenges, the entire ACA is in jeopardy with various courts across the nation hearing cases that may further impact the beleaguered Obama-era law. For now, consumers won’t face fines for not having insurance under government-approved plans for 2019.

It seems that short-term medical plans are disrupting the healthcare marketplace that politicians in Washington had tried to carefully control. When the dust settles and the lawsuits have come to an end, consumers may find they don’t need—and don’t want—government-subsidized major medical after all.

Short-term medical plans may evolve into the types of options consumers want at a price point they’re willing to pay while allowing companies to manage risk. Insurers may have inadvertently found a way to appease consumers’ desire for lower premiums while meeting their long-range goals and business modes.

The death of the ACA may be in the near future. We may find it replaced by short-term insurance.

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The Affordable Care Act (ACA), popularly known as “Obamacare,” has continued to evolve healthcare laws and how the government addresses public health issues. Four important changes are coming into play in 2019, but many consumers are unaware how these various proposals have the potential to affect their care.

When a new administration and a Republican-led Congress came to power in 2017, healthcare was a prominent political issue, and this trend has continued for two years. The whirlwind of proposals, votes, and debate in Washington politics has left many consumers confused as lawmakers wrestled to bring legislation to the table.

On May 4, 2017 the U.S. House of Representatives passed the American Health Care Act with a tight vote of 217 to 213. The Senate didn’t adopt this legislation so it never became law. Then on July 26, 2017 the U.S. Senate rejected a repeal of the ACA by a vote of 51 to 49 under proposed legislation called the Healthcare Freedom Act.

It was another swing and a miss. Finally, the Tax Cut and Jobs Act passed in December 2017 by a vote of 227 to 203, with an important provision for healthcare.

Here are the four changes to short-term health plans that will affect consumers in 2019.

1. End of the Individual Mandate

With the passage of the ACA in 2010, an “individual mandate” required Americans to purchase health insurance or face a penalty if they weren’t already covered by their employers or a program such as Medicare or Medicaid. The Tax Cut and Jobs Act repealed this portion of the ACA for 2019, giving taxpayers greater options for finding coverage.

While it was predicted that the end of the mandate would result in people dropping out of the exchanges, heavy federal subsidies that offset premiums in the marketplace seem to be keeping many Americans participating. It’s estimated that up to 80 percent of the population benefits from the subsidies.

With some room to breathe, many people who felt they weren’t benefiting from the exchanges or those who were young and healthy are likely to begin looking at all the options for healthcare coverage.

2. Rise of Short-Term Policies

With the changes made to the individual mandate, consumers were given an opportunity to purchase coverage under short-term health policies. These plans were initially offered as a temporary solution to bridge the gap when major medical coverage ended, when they weren’t eligible for an exemption or special enrollment period for a “qualifying life event,” or when consumers were waiting to enroll in the marketplace exchanges.

Because short-term health policies only cover the essential services consumers need, they often come with the added benefit of lower premiums. As a result of no longer requiring taxpayers to purchase coverage that meets “minimum essential coverage” (MEC), the strict government standards that a policy must meet or the insured pays a penalty, many people began flocking to these plans.

Insurers have responded favorably to the easing of federal restrictions. Many companies have expanded their offerings of short-term health policies, allowing consumers to customize their coverage and tailor the term of their insurance plans.

It’s expected that short-term health plans will continue to see vigorous growth.

3. Addressing the Opioid Crisis

In 2017, the U.S. Department of Health and Human Services (HHS) declared a public health emergency regarding the growing American opioid crisis. There is intense pressure to address doctors “over-prescribing” opioid medications.

The HHS estimated that at least 64,000 people died from opioid overdoses in 2016. By declaring the emergency, HHS could accelerate appointments of specialized personnel to address the crisis.

Consumers will likely see changes surrounding how doctors prescribe pain medications and how these prescriptions are handled.

4. Lower Drug Prices

Consumers have been complaining about rising drug prices for years, and it looks like their voices are finally being heard. In 2017, more new drugs came to market than any time since 1996, but they came with steep prices.

Insurers responded by launching into aggressive negotiations and financial deals that could result in more power within the drug market. It’s expected that all of this could create an opportunity for lower prices for consumers.

It’s also expected that Food and Drug Administration (FDA) chief Scott Gottlieb will expedite generics entering the market. In his keynote address at the 2018 Food and Drug Law Institute Annual Conference in May, Gottlieb called for greater competition to “improve access and support the market-based pricing that underwrites the high cost of new, lifesaving” drugs.

With so much attention being paid to healthcare and the cost for Americans to be healthy, politics in 2019 will continue to focus on this important issue.

In conclusion, 2019 will see consumers coming out on top as a result of these four changes to short-term health plans.

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Consumers looking for health insurance will be finding it easier in 2019. Premiums for individual plans are expected to stabilize, and less risk has enticed more providers to reenter the market.

For those who earn too much to qualify for a government subsidy, the cost of getting coverage can be prohibitive. But now short-term healthcare plans are looking like a better option for many Americans.

So What Happened?

Important changes to healthcare legislation are making temporary policies more attractive. In 2017, lawmakers passed the Tax Cut and Jobs Act with an important provision which repealed the most unpopular portion of the Affordable Care Act (ACA).

According to the Congressional Budget Office (CBO), by 2027 the individual marketplace is expected to grow by 10 percent as a result of the repeal. Standard & Poor’s estimated that 3 to 5 million wouldn’t have health insurance by that same year.

The “individual mandate” required that individuals purchase insurance policies that met strict ACA requirements or they’d pay a penalty if they couldn’t qualify for an exemption. This mandate of the healthcare law proved to be controversial and garnered heavy public criticism.

By 2015, more than 19 million Americans were without insurance, having to either claim an exemption or pay the penalty. About 6.5 million paid the fine, with the penalty averaging $470 according to the Internal Revenue Service (IRS).

As it turned out, for many Americans, the fine was significantly less than the cost of coverage through an ACA-compliant plan – and in many areas, only a handful of health plans were available. Many taxpayers complained that if they couldn’t afford to pay for health insurance, imposing a monetary penalty seemed counterproductive.

The purpose of the mandate was to force consumers to enter the marketplace by providing penalties for non-participation. This was promoted as a benefit – a win-win for everyone – so that insurers could offset the risk by participating in healthcare.gov marketplace exchanges.

The government required that health plans have “minimum essential coverage,” a major medical policy with established limits on deductibles, copayments, and out-of-pocket maximum amounts. These plans were robust in coverage and came with premiums to match.

Insurers couldn’t reject enrollees for preexisting conditions. Politicians decided that in order to offset this restriction, many more healthy Americans would have to buy insurance to spread the risk of the very sick over a larger pool.

As consumers fled the exchanges, the cost of the premiums climbed. This meant that those remaining in the pool were much sicker and more expensive to cover.

As a result of increased risk, plan providers in the exchanges increased the premiums to match, and even more healthy individuals left the ACA program. They were looking for an alternative to the expensive major medical plans that were government-mandated.

According to the CBO, premiums for what’s known as “benchmark plans” or the second lowest silver-level plan on the marketplace exchanges are expected to continue to increase 7 percent each year through 2028. The announcement came in October 2017 when the Department of Health and Human Services (HHS) reported that those same premiums would be rising an average of 37 percent for 2018. Yikes!

According to WorldatWork, salaries are expected to remain stagnant despite record unemployment. Salary budgets increased only 3.1 percent in 2018, and 2019 isn’t expected to be much better at 3.2 percent. It looks like healthcare premiums will devour more and more of the family budget.

More Options in 2019

Short-term healthcare plans were initially established as a temporary measure to provide some form of coverage in the event of loss of a job or some other situation that required consumers to wait for more traditional coverage. But there were advantages that made temporary health plans much more attractive.

The ability to customize short-term healthcare plans without all the Obamacare requirements along with significantly lower premiums proved to be an enormous enticement. Up until the repeal of the individual mandate, these policies weren’t ACA-compliant.

Additionally, a new ruling extended the term of these plans up to 364 days, with the ability to renew them to 36 months. It would seem that short-term healthcare plans didn’t have to be so short after all.

However, availability of short-term healthcare plans varies as some states place much tighter restrictions on these policies.

Short-term healthcare plans aren’t without risk, however. Critics point out that the coverage they provide is “skimpier” because they’re not major medical plans—also the reason for the lower cost. And they worry that some Americans won’t understand that temporary plans have limits on benefits as well as restrictions. Further, unlike ACA plans, enrollees can be rejected from short-term plans for preexisting conditions.

Nevertheless, many younger, healthier consumers are flocking to short-term healthcare plans in the hopes of gaining health coverage while avoiding skyrocketing premiums.

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A report by private health insurance exchange eHealth shows more consumers are choosing short-term health insurance plans even though they don’t meet the requirements of the Affordable Care Act (ACA). Data released by the company shows that for many consumers, these plans come with a much smaller premium cost over major medical coverage.

During the first half of Open Enrollment for 2018, 56 percent of eHealth customers opted for short-term coverage, and 44 percent selected plans without government subsidies.

What Consumers Want

The report supports assertions that consumers want greater choice in healthcare options while maintaining lower costs. Critics have been opposed to the government’s requirement for major medical coverage for everyone including young and healthy individuals due to the fact that it raises their premiums unnecessarily.

“The demand for alternative non-ACA plans is growing, driven by sustained premium spikes for Obamacare major medical coverage. The removal of the individual mandate at the end of this year and importantly the extension of the maximum allowed duration for short-term plans in many states,” eHealth CEO Scott Flanders told investors. “As a result, we expect to see more consumers come into the market and use these alternative plans as a more affordable substitute for major medical coverage.”

Short-term health insurance plans allows consumers to customize their policies to their specific needs and can come with a much lower monthly premium. Because insurers are able to offer different policies and benefits, there are more options to offer coverage than through the government’s marketplace exchange.

Background

The provision of the ACA known as the “individual mandate” was recently repealed for 2019. This portion of the healthcare legislation requires taxpayers purchase qualifying coverage or face penalties.

After several false starts to revise “Obamacare” as the law is popularly known, Congress managed to enact the Tax Cut and Jobs Act. While this wasn’t a full reform of the ACA and had little to do with healthcare, it did repeal the most unpopular portion of the law, which was the individual mandate.

For those who are unable to qualify for federal financial assistance, short-term health plans are often less expensive. The rising costs of premiums have been the chief complaint of those getting coverage through the government marketplace exchanges.

According to another report by eHealth, from 2016 to 2017, average monthly premiums increased 18 percent for individuals with coverage through the exchange. For the period when the major provisions of the ACA took effect in 2014 to 2017, premiums increased a whopping 39 percent.

Even with government subsidies, many consumers in some states were priced out of the exchanges due to skyrocketing premiums. Marketplace customers in Arizona saw their premiums increase a staggering 116 percent in 2017 alone.

Be Careful When Comparing

The premiums aren’t the same because benefits differ between a major medical policy and a short-term one. Many consumers may not be fully aware of the differences.

An ACA policy is often more robust. Under short-term coverage, insurers can reject enrollees if they have a preexisting condition such as diabetes, asthma, or high blood pressure, among other ailments. In addition, some services covered under major medical healthcare aren’t covered by temporary plans. Each plan can have much different benefits.

Experts warn that these policies could potentially harm consumers who don’t realize that some benefits aren’t offered or essential health conditions aren’t covered such as prescription drug coverage or maternity care. Supporters of the government program worry that these plans draw people away from the public marketplace, leaving only the sickest and least desirable customers in the risk pool, further driving up premiums.

Trend Expected to Continue

With the easing of restrictions and removal of the penalty, more customers are expected to look for alternatives to major medical coverage. Additionally, many of these plans have been extended from less than 90 days to a year, and some may be renewed up to three years.

“We also expect to see a significant increase in enrollment volume from our digital marketing efforts,” Flanders said. “In the under-65 business we continue to successfully shift our focus to selling short-term plans and non-ACA insurance packages at more attractive price points to meet our customer needs.”

Flanders predicts “an avalanche” of interest in short-term options in 2019 thanks to Trump administration rule changes.

“While the major medical market remains challenged, the short-term health insurance opportunity is attractive and allowed us to grow the total number of our approved members,” he told investors in October.

Americans will be able to benefit from the greater variety of short-term health plans available as well as the reduced hits on their wallets.

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Aetna reentered the short-term healthcare market after Congress and the Trump administration eased rules making temporary policies more attractive to consumers. Aetna short-term plans found new life in the fall of 2017, when the company evaluated its approach ahead of changes in the Affordable Care Act (ACA).

“We are actually looking at reenergizing a program we had prior to the [ACA] but… short-term, one-year kind of plan, or transition plan… So we have to think of what kind of plan it would look like and offer it as a transitionary plan over a year.”
-Aetna Chairman and CEO Mark T. Bertolini, speaking during the company’s third-quarter 2017 earnings conference call

Aetna’s October 31, 2017 communication to investors was a sign of major changes about to happen in the healthcare sector and of Washington’s commitment to reform healthcare for beleaguered consumers.

Washington Eased Restrictions

Donald Trump signed an executive order directing his administration to expand access to short-term healthcare policies, which had been severely restricted under the Obama presidency. The rule had limited short-term plans to a term of 90 days, and they didn’t qualify as government-compliant coverage.

Under the new order, insurers were permitted to sell policies with a term of up to 364 days. Temporary health plans were also allowed to be renewed for up to three years.

Known as short-term limited duration insurance (STLDI), these temporary plans were primarily intended for people between jobs or waiting for “Open Enrollment,” the annual period when consumers could sign up for healthcare under the ACA. Many consumers sought the plans as a bridge to cover periods when they were without insurance such as when they were awaiting Medicare to begin or immediately following a divorce.

Trump’s order would allow short-term policies to be offered in counties where few insurers were participating in the exchanges or by those who missed open enrollment. Many consumers saw short-term plans as a better option than the ACA’s major medical coverage, which many times offered benefits they neither needed nor wanted.

Consumers Benefit

Traditionally, these temporary plans cost about one-third of traditional major medical coverage found on healthcare.gov marketplace exchanges. The cost difference is largely due to the policies’ reduced benefits that don’t meet Obamacare’s “minimum essential” coverage (MEC).

Plans that are ACA-compliant meet established limits on deductibles, copayments, and out-of-pocket maximum amounts. In addition to covering a wide range of services, enrollees in an Obamacare plan cannot be rejected for preexisting conditions.

These plans were robust in coverage and came with hefty premiums to match. Many consumers who participated in the government-compliant healthcare programs complained about rising premium costs.

In October 2017, the Department of Health and Human Services (HSS) reported that premiums for the second lowest silver-level plan on the marketplace exchanges would be rising an average of 37 percent for 2018. Those same plans are expected to continue to increase seven percent each year through 2028.

But higher premiums weren’t the only objection. Consumers were unhappy about disincentives built into Obamacare.

One of the most controversial provisions of the ACA was the “individual mandate,” which penalized consumers who didn’t purchase insurance policies that met government guidelines and couldn’t qualify for an exemption. In 2017, lawmakers passed the Tax Cut and Jobs Act with a small but important provision that repealed the mandate.

Consumers found the plans to be more affordable, but critics are worried that they may not understand the limits of their coverage. Additionally, individuals can be rejected for a preexisting condition under a short-term plan, something that couldn’t happen under Obamacare.

New Direction

In May 2017, Aetna announced it would pull out of the ACA marketplace exchanges the following year. The announcement came as a blow to Obamacare supporters as the insurance giant joined an exodus of companies leaving state exchanges.

“Aetna’s decision to completely withdraw from the Obamacare exchanges adds to the mountain of evidence that Obamacare has failed the American people. Repealing and replacing it with patient-centered solutions that stabilize the marketplace to bring down costs and increase choices is the only solution,” said Tom Price, Health and Human Services Secretary at the time. (Price resigned in September 2017.)

This decision came after Aetna reported that its commercial products lost nearly $700 million between 2014 and 2016. The company had projected to lose more than $200 million in 2017—partly due to the deterioration of the risk pool.

The intent to offer Aetna short-term plans is seen as a positive sign for the company and an indication that consumers will see greater options being offered in temporary plans. We’ll bring you more information about Aetna short-term plans as it becomes available.

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In the 2018 midterm elections, the Democratic Party rode to victory in the House of Representatives on a changing political tide driven by healthcare. It may be this very issue that proves to be the Party’s undoing in the 2020 general election—again.

In battleground states where highly contentious races between candidates played out on the public stage, liberals banked on an electorate wanting the government to address health insurance coverage while conservatives focused on immigration. A tracking poll by the Henry J. Kaiser Family Foundation found that across the nation, 71 percent of voters reported that healthcare was “very important” in determining how they would cast their ballot while immigration not so much.

It wasn’t the availability of coverage or the conditions and benefits, but the actual costs of the premiums that concerned the electorate—a point that perhaps Democrats may have missed. The election results speak to the effectiveness of both of the parties’ strategies.

When the dust settled, Democrats controlled the House with a final tally of 235 to 199. Although they gained a few key committee chairs, Republicans managed to retain control of the Senate 53 to 47.

If history is any indication of what lies ahead, Democrats might have a tough time in 2020 over the issue of healthcare. Another possibility is that the voters have learned that nothing in life is free and they’ll have to make certain painful sacrifices to get the type of health services they want.

How We Got Here

The Republican-led Congress made several ultimately failing attempts by to pass some form of healthcare reform in 2017. After close calls and near misses, the Republican Party was able to successfully undo the most unpopular provision of the Affordable Care Act (ACA) with passage of the Tax Cut and Jobs Act in December 2017.

This law repealed the “individual mandate” which required Americans who could afford it to purchase health insurance. It wasn’t just any policy either as taxpayers were forced to have specific types of coverage.

The ACA required that participants enroll in plans that met the “minimum essential requirement” (MEC), a standard of qualifying healthcare coverage. Those who failed to do so and weren’t eligible for an exemption would pay a penalty known as an individual “shared responsibility payment.”

It was that fine that proved unpopular back in 2016 and likely cost the Democratic Party several races in the last general election. It was healthcare that led to GOP domination in Washington.

How Unpopular Was the Mandate?

Depending on how pollsters framed the question, somewhere between 50 percent and 63 percent of voters found the individual mandate unfavorable way back in November 2016. However, it should be noted that since that time more Democrats and independents have warmed to the idea.

But what cost many races was the big disadvantage of the ACA because many of its provisions were dependent on each other. The individual mandate had a strong basis on protections for people with preexisting conditions.

The rationale was that if insurers were forced to cover everyone, then they should benefit from a larger pool of participants to share in the risk. Forcing compliance in the program with monetary penalties would provide the numbers needed.

The result was that relatively healthy individuals ended up subsidizing older, sicker Americans. They were obliged to pay higher premiums for coverage they were unlikely to ever use.

And they were very unhappy about it.

Unlikely Alternative

Many people transitioned out of employer-sponsored plans or marketplace exchanges and needed interim coverage. They found a solution via plans that focused on short-term healthcare that didn’t meet ACA requirements and yet still covered the basics.

These short-term healthcare plans were originally designed as temporary policies meant to bridge a gap between jobs while waiting for circumstances to change or the next ACA open enrollment. Few people understood that these skinnier plans were going to transform the insurance industry—and, by extension, future political races as a result.

The short-term healthcare approach was all about providing customized plans, with only the benefits that the consumer wanted. No more minimum essential requirements or major medical premiums to make health care unaffordable.

Often these policies were less expensive than those found in marketplace exchanges. And they coincided with the end of the individual mandate.

What this gave voters was affordable policies through short-term healthcare at the cost savings they had been demanding since 2016. And this is likely what Democrats will want to undo.

The question is whether voters will accept going back to higher premiums because of bloated coverage and forced penalties. The nation will find out in the next general election.

We promise to keep you posted!

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