Public Comments for 01/20/2022 Commerce and Energy
HB237 - Health insurance; short-term limited-duration medical plans.
I am writing in opposition to HB237. This bill will roll back important consumer protections on Short-Term Limited-Duration (STLD) plans passed by the General Assembly in 2020. These plans are intended to fill short coverage gaps, not provide full-year coverage. They can exclude coverage for prescription drugs, maternity benefits, mental health, substance use disorders, or pre-existing health conditions; deny coverage, deny a renewal, or exclude services because of a pre-existing condition; charge more based on gender or a pre-existing condition; and have daily, annual, or lifetime limits on benefits. Further, they spend less on enrollee benefits, about $.39 per premium dollar, than qualified health plans, which are required to spend $.80-$.85 of every premium dollar on benefits. Numerous studies have shown that STLD plans are often misrepresented to consumers, and many purchase them without knowing their limitations. I urge you to vote no on this bill.
My name is Freddy Mejia with The Commonwealth Institute and the Healthcare for All Virginians Coalition. Investing in behavioral health has been identified as a priority for the legislature. However, I firmly believe that expanding access to short-term limited-duration health plans that often do not provide mental health and substance use disorder services is counterproductive to those efforts. We are concerned that these plans, which lack many consumer protections, will leave more families in Virginia underinsured and at risk of medical debt. We are opposed to this bill and ask you to please vote no on HB237.
The American Cancer Society Cancer Action Network (ACSCAN) opposes HB237. Short-term limited duration (STLD) insurance plans do not provide the kind of comprehensive insurance coverage cancer patients need. These plans were designed only as temporary coverage and are not subject to the same Affordable Care Act (ACA) requirements as other health insurance products on the market. For instance, STLD plans are not required to provide a robust benefit package. As a result, an enrollee who was attracted to the plan’s lower premiums may find – if they are diagnosed with a serious illness like cancer – that the plan does not cover all of their necessary cancer treatments. In these cases, the consumer can be left with catastrophic costs. STLD plans fail to provide the kind of comprehensive coverage an individual would need if they were diagnosed with a serious and unplanned disease such as cancer. STLD plans can (and most do): - Engage in medical underwriting: issuers can deny coverage to people with pre-existing conditions, charge more based on a person’s health status, or refuse to cover services related to an individual’s pre-existing conditions; - Impose lifetime and annual limits on coverage; - Exclude coverage of essential health benefits; - Engage in post-claims underwriting – once a person is enrolled in coverage if they submit claims for an expensive service, the issuer investigates to determine whether the enrollee’s condition was a ‘pre-existing condition’ – and deny coverage for the condition; - End coverage at the policy’s term, even if the policyholder has gotten sick and needs coverage to continue; and - Negatively impact the risk pool and availability and affordability of ACA-compliant plans by syphoning off younger, healthier consumers who will be more likely to purchase cheaper, bare bones plans. For these reasons we urge the committee to leave the STLD restrictions in place and vote down HB37
The Leukemia & Lymphoma Society respectfully submits this written testimony in opposition to HB 237 concerning short-term limited duration plans. LLS's concern is that the proliferation of these plans will leave many patients underinsured.
Short-Term Limited Duration Plans (HB237) Short-term limited duration (STLD) health plans were originally intended to fill a temporary gap in health coverage. This type of plan was not meant to replace traditional long-term health care coverage options. They lack many consumer protections. This is why AARP Virginia supported 2020 legislation to impose limitations on the sale of STLD health plans in Virginia, which HB237 would repeal. Short-term limited duration health plans are not required to cover prescription drugs, mental health and substance use disorders, and pre-existing health conditions. A February 2020 Milliman Research Report found that 58 percent of plans didn’t cover mental health services and 67 percent of plans didn’t cover prescription drug benefits. Unlike ACA compliant plans, STLD plans can charge higher premiums to people based on their gender. They can charge older people far higher premiums than currently allowed by the ACA. Short-term plans also can charge high deductibles and cost-sharing for the benefits they do cover (e.g., a $5,000 deductible for a policy that lasts three or six months). And, the plans can include dollar limits and caps on how much they will pay out for a given service or in total for benefits over the life of the policy, or during the life of the enrollee. The applicable Medical Loss Ratio permits up to 40% of premiums collected to cover administrative costs and profits (vs. only 15% in the individual market.) Additionally, increased marketplace subsidies make this sort of legislation to expand access to these types of plans really unnecessary. Overall, short-term health plans are a bad deal for consumers, and Virginia should not broaden their availability. As such, AARP Virginia asks that you vote “no” on HB237.
The American Lung Association believes everyone should have quality and affordable healthcare coverage. While the federal government has expanded the use of short-term, limited duration insurance plans (known as short-term plans), these plans can deny coverage based on pre-existing conditions like lung disease and do not provide the comprehensive coverage that individuals need to stay healthy. The current COVID-19 pandemic emphasizes the critical nature of access to comprehensive, quality coverage, regardless of pre-existing conditions. The American Lung Association in Virginia urges members to oppose House Bill 237, legislation that would rollback safeguards for consumers purchasing short-term plans in Virginia. Protections for Virginians were passed in 2020 in Senate Bill 404. Repealing these protections will harm patients with asthma, COPD, lung cancer and other lung diseases. Under federal regulations, short-term plans almost always refuse coverage to patients with pre-existing health conditions. Current lung disease patients, like patients with COPD or lung cancer survivors, could be denied coverage because of these health conditions. Individuals who buy a short-term plan and then receive a new lung disease diagnosis in the middle of a plan year could find the coverage for their disease rescinded, leaving them without any coverage options until the open enrollment period for Virginia’s individual marketplace comes around. Short-term plans are not required to provide coverage for basic treatments and services that individuals need – even if they are healthy now. For example, these plans do not have to cover preventive services like lung cancer screening or tobacco cessation treatment, nor do they have to cover essential health benefits like hospitalizations and prescription drug coverage. This will create confusion for consumers trying to purchase comprehensive coverage and could leave patients with massive medical bills or force them to forgo needed treatment if they get sick. Short-term plans also often require consumers to spend enormous sums during the deductible portion of their benefit design, which can quickly eclipse any premium savings consumers may accrue while covered by one of these plans.1 Additionally, short-term plans will likely attract younger and healthier individuals, dividing the individual marketplace risk pool in Virginia. That will result in a spike in premiums for comprehensive plans sold in the marketplace, the only ones that will cover the treatments and services that lung disease patients need. Patients with lung disease should not have to pay higher premiums because they need coverage for a pre-existing condition. Even those consumers who seek a comprehensive ACA plan may be diverted to a Short-term plan through deceptive marketing and misleading websites.1 The American Lung Association in Virginia urges lawmakers to support the safeguards for consumers purchasing short-term plans that were passed in 2020 through Senate Bill 404 and Oppose House Bill 237 which would roll back these protections and harm Virginians. 1 Under-Covered: How “Insurance Like” Products Are Leaving Patients Exposed. 2021 https://www.lung.org/getmedia/5b240c9a-72ec-4217-bc75-d416e6f69f51/undercovered_report.pdf
The National Multiple Sclerosis Society writes to express strong opposition to the removal of limitations on the duration, renewal, and availability of short term limited duration health plans. We respectfully urge the Committee to vote NO on HB 237. The Society has a unique perspective on what people with multiple sclerosis (MS) require to manage their disease and live their best lives. MS is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Virginians impacted by MS should not have to worry whether their health insurance will cover their doctor visits, care for COVID-19, or treatment for complex, chronic conditions like multiple sclerosis. All Virginians deserve health insurance that is comprehensive and includes patient protections, covers an expansive network of providers and plan features, and provides simple and clear information regarding plan costs and coverage. Short term limited duration plans fail to meet these standards, and place people living with MS at great risk for medical debt and high out-of-pocket costs. Given the risk these plans pose to Virginians living with MS, the Society was supportive of efforts in 2020 to place common-sense limitations on STLD plans. We strongly oppose any effort to remove these limitations, as called for in HB 237.
The Virginia Breast Cancer Foundation (VBCF) opposes HB 237, which repeals prohibitions on the duration, renewal and extension, and availability of short-term limited-duration medical plans (STLDPs). These health insurance plans can serve as a stop-gap measure for some consumers, but should be kept “short-term” as currently available. VBCF's concern is that STLDPs are not required to adhere to a vast range of important patient protections and are a poor coverage option for consumers who may encounter a serious diagnosis - such as breast cancer - while holding such limited coverage. Among other things, they can refuse coverage for pre-existing conditions and choose not to cover essential health care services, including cancer screenings. Many individuals with STLDPs who become sick will be unable to afford the care needed to respond to a life-threatening or life-changing diagnosis and will be forced to delay treatment for the months it may take to secure adequate coverage. At VBCF we know that early diagnosis and treatment of breast cancer leads to better outcomes for patients. Limited health plans that do not cover essential health care services such as cancer screenings are not a good choice for many consumers. Expanding the duration, renewal, and extension of STLDPs is moving in the wrong direction for Virginia. We oppose HB 237.
HB268 - Credit unions; priority of shares.
HB358 - Veteran-owned small businesses; waiving of fees.
As the relative of many veterans and the next generation serving, I hope that the committee will look favorably on helping out our veterans. Thank you.
As the relative and friend of many veterans, thank you for doing this study to help our vets out. Please consider how this would help on their behalf.
HB203 - Financial institutions; qualified education loan servicers, definitions.
We oppose HB 203. Virginia just started regulating student loan servicers a few months ago. The regulation was necessary to prevent some servicers from taking advantage of the students they are hired to serve. HB 203 will limit the scope of this new law and regulations before we have had a chance to see how it is working. The proposed legislation is attempting to narrow the definition of a “qualified education servicer” most likely to exclude guaranty agencies from regulation. However, the definition of qualified education loan servicer in current Virginia law is taken from the federal definition. Changing our definition now would put Virginia’s law out of sync with federal law. Since 2014, the Consumer Protection Financial Bureau has supervised Guaranty Agencies as student loan servicers. Guaranty agencies are a combination insurance company, loan servicer, and debt collector, as they ensure student loans, advise borrowers about repayment options, and collect debt should a loan ultimately default. Advising borrowers about repayment options is student loan servicing.
Please see the attached written comment in opposition to HB 203, submitted as a PDF.